Tolerogenic synthetic nanocarriers to reduce or prevent anaphylaxis in response to a non-allergenic antigen

ABSTRACT

This invention relates to methods for reducing or preventing anaphylaxis to non-allergenic antigens with compositions comprising immunosuppressants, and related compositions.

RELATED APPLICATIONS

This application claims the benefit under 35 U.S.C. § 119 of U.S.provisional applications 61/819,517, filed May 3, 2013; 61/881,851,filed Sep. 24, 2013; 61/881,913, filed Sep. 24, 2013; 61/881,921, filedSep. 24, 2013; 61/907,177, filed Nov. 21, 2013; 61/948,313, filed Mar.5, 2014; and 61/948,384, filed Mar. 5, 2014, the entire contents of eachof which are incorporated herein by reference.

FIELD OF THE INVENTION

This invention relates to methods for reducing or preventing anaphylaxisto non-allergenic antigen with compositions comprisingimmunosuppressants, and related compositions. The methods andcompositions allow for reduction or prevention of anaphylaxisdevelopment as a result of non-allergenic antigens, such asnon-allergenic therapeutic macromolecules. Thus, methods andcompositions are provided that can be used to reduce or preventanaphylaxis due to the administration of a non-allergenic antigen, suchas a non-allergenic therapeutic macromolecule.

BACKGROUND OF THE INVENTION

Conventional immunosuppressant drugs are broad-acting. Additionally, inorder to maintain immunosuppression, immunosuppressant drug therapy isgenerally a life-long proposition. Unfortunately, the use ofbroad-acting immunosuppressants are associated with a risk of severeside effects, such as tumors, infections, nephrotoxicity and metabolicdisorders. Accordingly, new antigen-specific tolerogenic therapies wouldbe beneficial.

SUMMARY OF THE INVENTION

In one aspect, a method for reducing or preventing an anaphylacticreaction to a non-allergenic antigen, comprising providing thenon-allergenic antigen, the non-allergenic antigen being unattached tosynthetic nanocarriers; providing a composition comprising syntheticnanocarriers, in some embodiments, attached to an immunosuppressant; andadministering to a subject the composition concomitantly with thenon-allergenic antigen. In one embodiment of any one of the methodsprovided, the concomitant administration to the subject is according toa protocol that has been demonstrated to reduce or prevent ananaphylactic reaction to the non-allergenic antigen. In anotherembodiment of any one of the methods provided, the method furthercomprises determining the protocol.

In another embodiment of any one of the methods provided, the methodfurther comprises assessing the anaphylactic reaction in the subjectprior to and/or after the administration.

In another embodiment of any one of the methods provided, theadministering is by intravenous, intraperitoneal or subcutaneousadministration.

In another embodiment of any one of the methods provided, the methodfurther comprises recording a reduction or prevention of an anaphylacticreaction to the non-allergenic antigen.

In another embodiment of any one of the methods provided, theimmunosuppressant comprises a statin, an mTOR inhibitor, a TGF-βsignaling agent, a corticosteroid, an inhibitor of mitochondrialfunction, a P38 inhibitor, an NF-κB inhibitor, an adenosine receptoragonist, a prostaglandin E2 agonist, a phosphodiesterase 4 inhibitor, anHDAC inhibitor or a proteasome inhibitor. In another embodiment of anyone of the methods provided, the mTOR inhibitor is rapamycin.

In another embodiment of any one of the methods provided, thenon-allergenic comprises a therapeutic macromolecule. In anotherembodiment of any one of the methods provided, the therapeuticmacromolecule is a therapeutic protein or a therapeutic polynucleotide.In another embodiment of any one of the methods provided, thetherapeutic protein is for protein replacement of proteinsupplementation therapy. In another embodiment of any one of the methodsprovided, the therapeutic protein comprises a/an infusible or injectabletherapeutic protein, enzyme, enzyme cofactor, hormone, blood or bloodcoagulation factor, cytokine, interferon, growth factor, monoclonalantibody, polyclonal antibody, or protein associated with Pompe'sdisease. In another embodiment of any one of the methods provided, theinfusible or injectable thereapeutic protein comprises Tocilizumab,alpha-1 antitrypsin, Hematide, albinterferon alfa-2b, Thucin,tesamorelin, ocrelizumab, belimumab, pegloticase, taliglucerase alfa,agalsidase alfa, or velaglucerase alfa. In another embodiment of any oneof the methods provided, the enzyme comprises an ocidforeductase,transferase, hydrolase, lysase, isomerase or ligase. In anotherembodiment of any one of the methods provided, the enzyme comprises anenzyme for enzyme replacement therapy for a lysosomal storage disorder.In another embodiment of any one of the methods provided, the enzyme forreplacement therapy for a lysosomal storage disorder comprisesimiglucerase, a-galactosidase A (a-gal A), agalsidase beta, acidα-glucosidase (GAA), alglucosidase alfa, LUMIZYME, MYOZYME,arylsulfatase B, laronidase, ALDURAZYME, idursulfase, ELAPRASE,arylsulfatase B, pegloticase, pegsiticase or NAGLAZYME. In anotherembodiment of any one of the methods provided, the cytokine comprises alymphokine, interleukin, chemokine, type 1 cytokine or a type 2cytokine. In another embodiment of any one of the methods provided, theblood or blood coagulation factor comprises Factor I, Factor II, tissuefactor, Factor V, Factor VII, Factor VIII, Factor IX, Factor X, FactorXa, Factor XII, Factor XIII, von Willebrand factor, prekallikrein,high-molecular weight kininogen, fibronectin, antithrombin III, heparincofactor II, protein C, protein S, protein Z, protein Z-related proteaseinhibitor (ZPI), plasminogen, alpha 2-antiplasmin, tissue plasminogenactivator (tPA), urokinase, plasminogen activator inhibitor-1 (PAI1),plasminogen activator inhibitor-2 (PAI2), cancer procoagulant or epoetinalfa.

In another embodiment of any one of the methods provided, a load ofimmunosuppressant attached to the synthetic nanocarriers, on averageacross the synthetic nanocarriers, is between 0.1% and 50%. In anotherembodiment of any one of the methods provided, the load is between 0.1%and 20%.

In another embodiment of any one of the methods provided, the syntheticnanocarriers comprise lipid nanoparticles, polymeric nanoparticles,metallic nanoparticles, surfactant-based emulsions, dendrimers,buckyballs, nanowires, virus-like particles or peptide or proteinparticles. In another embodiment of any one of the methods provided, thesynthetic nanocarriers comprise lipid nanoparticles. In anotherembodiment of any one of the methods provided, the syntheticnanocarriers comprise liposomes. In another embodiment of any one of themethods provided, the synthetic nanocarriers comprise metallicnanoparticles. In another embodiment of any one of the methods provided,the metallic nanoparticles comprise gold nanoparticles. In anotherembodiment of any one of the methods provided, the syntheticnanocarriers comprise polymeric nanoparticles. In another embodiment ofany one of the methods provided, the polymeric nanoparticles comprisepolymer that is a non-methoxy-terminated, pluronic polymer. In anotherembodiment of any one of the methods provided, the polymericnanoparticles comprise a polyester, polyester attached to a polyether,polyamino acid, polycarbonate, polyacetal, polyketal, polysaccharide,polyethyloxazoline or polyethyleneimine. In another embodiment of anyone of the methods provided, the polyester comprises a poly(lacticacid), poly(glycolic acid), poly(lactic-co-glycolic acid) orpolycaprolactone. In another embodiment of any one of the methodsprovided, the polymeric nanoparticles comprise a polyester and apolyester attached to a polyether. In another embodiment of any one ofthe methods provided, the polyether comprises polyethylene glycol orpolypropylene glycol.

In another embodiment of any one of the methods provided, the mean of aparticle size distribution obtained using dynamic light scattering ofthe synthetic nanocarriers is a diameter greater than 100 nm. In anotherembodiment of any one of the methods provided, the diameter is greaterthan 150 nm. In another embodiment of any one of the methods provided,the diameter is greater than 200 nm. In another embodiment of any one ofthe methods provided, the diameter is greater than 250 nm. In anotherembodiment of any one of the methods provided, the diameter is greaterthan 300 nm.

In another embodiment of any one of the methods provided, an aspectratio of the synthetic nanocarriers is greater than 1:1, 1:1.2, 1:1.5,1:2, 1:3, 1:5, 1:7 or 1:10.

In another aspect, a composition or kit comprising immunosuppressants,in some embodiments attached to synthetic nanocarriers; and anon-allergenic antigen, the non-allergenic antigen being unattached tosynthetic nanocarriers, is provided. In one embodiment, the compositionor kit is for use in any one of the methods provided herein. In anotherembodiment, the composition or kit further comprises a pharmaceuticallyacceptable carrier. In another embodiment, the immunosuppressants andnon-allergenic antigen are contained in the same container. In anotherembodiment, the immunosuppressants and non-allergenic antigen arecontained in separate containers. In another embodiment, the compositionor kit further comprises instructions for use.

In another aspect, a method of manufacturing any one of the compositionsor kits provided herein is provided, the method comprising combining theelements of the composition or kit. In one embodiment, one or more ofthe elements of the composition or kit are prepared. Accordingly, anyone of the methods of manufacturing can comprise a step of preparing acomposition of immunosuppressants and preparing a composition ofnon-allergenic antigen. In one embodiment, the step of preparing acomposition of immunosuppressants can comprise attaching theimmunosuppressants to synthetic nanocarriers.

In another embodiment, the method of manufacturing comprises producing adose or dosage form of a non-allergenic antigen and producing a dose ordosage form of an immunosuppressant. In another embodiment, the step ofproducing a dose or dosage form of an immunosuppressant comprisesattaching the immunosuppressant to synthetic nanocarriers. In anotherembodiment of any one of the methods of manufacturing provided, themethod further comprises combining the dose or dosage form of theimmunosuppressant and dose or dosage form of non-allergenic antigen in akit.

In another aspect, a use of any of the compositions or kits providedherein for the manufacture of a medicament for reducing or preventing ananaphylactic reaction to a non-allergenic antigen, in a subject isprovided. In one embodiment, the composition or kit comprises animmunosuppressant and a non-allergenic antigen. In another embodiment ofany one of the uses provided herein, the immunosuppressant is attachedto synthetic nanocarriers.

In another aspect, any one of the compositions or kits provided hereincan be for use in any one of the methods provided herein.

In another aspect, a method of manufacturing a medicament intended forreducing or preventing an anaphylactic reaction to a non-allergenicantigen is provided. In one embodiment, the medicament comprises animmunosuppressant and a non-allergenic antigen. In another embodiment ofany one of the methods of manufacturing provided herein, theimmunosuppressant is attached to synthetic nanocarriers.

In another aspect, a method of manufacturing a composition or kitcomprising preparing or obtaining immunosuppressant, in some embodimentsattached to synthetic nanocarriers, and a non-allergenic antigen, thenon-allergenic antigen being unattached to synthetic nanocarriers isprovided.

BRIEF DESCRIPTION OF FIGURES

FIG. 1 shows IgG titers are reduced as a result of an inventivetreatment.

FIG. 2 shows the reduction in IgG titers and anaphylactic score as aresult of an inventive treatment.

FIG. 3 shows the reduction in anaphylactic score as a result of aninventive treatment.

FIG. 4 shows the reduction in IgG titers as a result of an inventivetreatment.

DETAILED DESCRIPTION OF THE INVENTION

Before describing the present invention in detail, it is to beunderstood that this invention is not limited to particularlyexemplified materials or process parameters as such may, of course,vary. It is also to be understood that the terminology used herein isfor the purpose of describing particular embodiments of the inventiononly, and is not intended to be limiting of the use of alternativeterminology to describe the present invention.

All publications, patents and patent applications cited herein, whethersupra or infra, are hereby incorporated by reference in their entiretyfor all purposes.

As used in this specification and the appended claims, the singularforms “a,” “an” and “the” include plural referents unless the contentclearly dictates otherwise. For example, reference to “a polymer”includes a mixture of two or more such molecules or a mixture ofdiffering molecular weights of a single polymer species, reference to “asynthetic nanocarrier” includes a mixture of two or more such syntheticnanocarriers or a plurality of such synthetic nanocarriers, reference to“a RNA molecule” includes a mixture of two or more such RNA molecules ora plurality of such RNA molecules, reference to “an immunosuppressant”includes a mixture of two or more such materials or a plurality of suchimmunosuppressant molecules, and the like.

As used herein, the term “comprise” or variations thereof such as“comprises” or “comprising” are to be read to indicate the inclusion ofany recited integer (e.g. a feature, element, characteristic, property,method/process step or limitation) or group of integers (e.g. features,element, characteristics, properties, method/process steps orlimitations) but not the exclusion of any other integer or group ofintegers. Thus, as used herein, the term “comprising” is inclusive anddoes not exclude additional, unrecited integers or method/process steps.

In embodiments of any one of the compositions and methods providedherein, “comprising” may be replaced with “consisting essentially of” or“consisting of”. The phrase “consisting essentially of” is used hereinto require the specified integer(s) or steps as well as those which donot materially affect the character or function of the claimedinvention. As used herein, the term “consisting” is used to indicate thepresence of the recited integer (e.g. a feature, element,characteristic, property, method/process step or limitation) or group ofintegers (e.g. features, element, characteristics, properties,method/process steps or limitations) alone.

A. Introduction

Anaphylaxis is generally associated with allergic responses toallergens. However, anaphylaxis can also occur in response toadministration of a non-allergenic antigen, such as a non-allergenictherapeutic macromolecule. Surprisingly, it have been found thatsynthetic nanocarriers attached to immunosuppressants administeredconcomitantly with non-allergenic antigens can be successfully used toblock the immune pathways responsible for anaphylaxis to anon-allergenic antigen. Thus, the methods and compositions providedherein are useful for treating subject in need of therapy with anon-allergenic therapeutic macromolecule, particularly where the subjectis at risk of anaphylaxis as a result of such treatment.

It has been found that delivering doses of immunosuppressantsconcomitantly with non-allergenic antigens can effectively reduce orprevent anaphylaxis related to the non-allergenic antigens. The doses ofsuch immunosuppressants when concomitantly administered with anon-allergenic antigen were surprisingly found to reduce or preventanaphylaxis even when non-allergenic antigen is subsequentlyadministered without further administration of the immunosuppressants.Thus, the doses of immunosuppressants concomitantly administered withnon-allergenic antigen provide long-term protection from anaphylaxis. Assuch immune responses can be beneficial in countering anaphylaxis duringtherapeutic treatment with non-allergenic therapeutic macromolecules,the invention can be useful for promoting tolerogenic immune responsesin subjects in need of treatment with a non-allergenic therapeuticmacromolecule.

The inventors have unexpectedly and surprisingly discovered that theproblems and limitations noted above can be overcome by practicing theinvention disclosed herein. The present invention is illustrated in theExamples below.

The invention will now be described in more detail below.

B. Definitions

“Administering” or “administration” or “administer” means providing amaterial to a subject in a manner that is pharmacologically useful. Theterm is intended to include “causing to be administered” in someembodiments. “Causing to be administered” means causing, urging,encouraging, aiding, inducing or directing, directly or indirectly,another party to administer the material.

“Amount effective” in the context of a composition or dosage form foradministration to a subject refers to an amount of the composition ordosage form that produces one or more desired responses in the subject,for example, the generation of a tolerogenic immune response (e.g., areduction in or prevention of anaphylaxis). This amount can refer to asingle dose or multiple doses. Therefore, in some embodiments, an amounteffective is the amount of any composition provided herein given asmultiple doses that produces one or more of these desired immuneresponses and/or therapeutic effects as provided herein. The amounteffective can be for in vitro or in vivo purposes. For in vivo purposes,the amount can be one that a clinician would believe may have a clinicalbenefit for a subject in need of reducing or preventing an anaphylacticreaction in a subject as a result of a non-allergenic antigen.

Amounts effective can involve reducing the level of an undesired immuneresponse, although in some embodiments, it involves preventing anundesired immune response altogether. Amounts effective can also involvedelaying the occurrence of an undesired immune response. An amount thatis effective can also be an amount of a composition provided herein thatproduces a desired therapeutic endpoint or a desired therapeutic result.Amounts effective, preferably, result in a tolerogenic immune responsein a subject to an antigen, such as a non-allergenic antigen. Theachievement of any of the foregoing can be monitored by routine methods.

In some embodiments of any one of the compositions and methods provided,the amount effective is one in which the desired immune responsepersists in the subject for at least 1 week, at least 2 weeks or atleast 1 month. In other embodiments of any of the compositions andmethods provided, the amount effective is one which produces ameasurable desired immune response, for example, a measurable decreasein an immune response (e.g., to a specific non-allergenic antigen), forat least 1 week, at least 2 weeks or at least 1 month.

Amounts effective will depend, of course, on the particular subjectbeing treated; the severity of a condition, disease or disorder; theindividual patient parameters including age, physical condition, sizeand weight; the duration of the treatment; the nature of concurrenttherapy (if any); the specific route of administration and like factorswithin the knowledge and expertise of the health practitioner. Thesefactors are well known to those of ordinary skill in the art and can beaddressed with no more than routine experimentation. It is generallypreferred that a maximum dose be used, that is, the highest safe doseaccording to sound medical judgment. It will be understood by those ofordinary skill in the art, however, that a patient may insist upon alower dose or tolerable dose for medical reasons, psychological reasonsor for virtually any other reason.

In general, doses of the immunosuppressants and/or non-allergenicantigens in the compositions of the invention can refer to the amount ofthe immunosuppressants and/or non-allergenic antigens. Alternatively,the dose can be administered based on the number of syntheticnanocarriers, such as synthetic nanocarriers that provide the desiredamount of immunosuppressants.

“Antigen-specific” refers to any immune response that results from thepresence of the antigen, or portion thereof, or that generates moleculesthat specifically recognize or bind the antigen. When the antigen is anon-allergenic antigen, antigen-specific may mean non-allergenicantigen-specific. For example, where the immune response isantigen-specific antibody production, antibodies are produced thatspecifically bind the antigen.

“Assessing an immune response” refers to any measurement ordetermination of the level, presence or absence, reduction, increase in,etc. of an immune response in vitro or in vivo. Such measurements ordeterminations may be performed on one or more samples obtained from asubject. Such assessing can be performed with any of the methodsprovided herein or otherwise known in the art. The assessing may beassessing the reduction, prevention, presence or absence of ananaphylactic reaction to a non-allergenic antigen.

“Attach” or “Attached” or “Couple” or “Coupled” (and the like) means tochemically associate one entity (for example a moiety) with another. Insome embodiments, the attaching is covalent, meaning that the attachmentoccurs in the context of the presence of a covalent bond between the twoentities. In non-covalent embodiments, the non-covalent attaching ismediated by non-covalent interactions including but not limited tocharge interactions, affinity interactions, metal coordination, physicaladsorption, host-guest interactions, hydrophobic interactions, TTstacking interactions, hydrogen bonding interactions, van der Waalsinteractions, magnetic interactions, electrostatic interactions,dipole-dipole interactions, and/or combinations thereof. In embodiments,encapsulation is a form of attaching. In embodiments, non-allergenicantigens and immunosuppressants are not attached to one another, meaningthat the antigens and immunosuppressants are not subjected to a processspecifically intended to chemically associate one with another. Inembodiments, non-allergenic antigens are not attached to syntheticnanocarriers, meaning that the antigens and synthetic nanocarriers arenot subjected to a process specifically intended to chemically associateone with another.

“Average”, as used herein, refers to the arithmetic mean unlessotherwise noted.

“Combination”, as applied to two or more materials and/or agents (alsoreferred to herein as the components), is intended to define material inwhich the two or more materials/agents are associated. Components may beseparately identified, e.g. first component, second component, thirdcomponent, etc. The terms “combined” and “combining” in this context areto be interpreted accordingly.

The association of the two or more materials/agents in a combination maybe physical or non-physical. Examples of physically associated combinedmaterials/agents include:

-   -   compositions (e.g. unitary formulations) comprising the two or        more materials/agents in admixture (for example within the same        unit dose);    -   compositions comprising material in which the two or more        materials/agents are chemically/physicochemically linked (for        example by crosslinking, molecular agglomeration or binding to a        common vehicle moiety);    -   compositions comprising material in which the two or more        materials/agents are chemically/physicochemically co-packaged        (for example, disposed on or within lipid vesicles, particles        (e.g. micro- or nanoparticles) or emulsion droplets);    -   pharmaceutical kits, pharmaceutical packs or patient packs in        which the two or more materials/agents are co-packaged or        co-presented (e.g. as part of an array of unit doses);

Examples of non-physically associated combined materials/agents include:

-   -   material (e.g. a non-unitary formulation) comprising at least        one of the two or more materials/agents together with        instructions for the extemporaneous association of the at least        one compound/agent to form a physical association of the two or        more materials/agents;    -   material (e.g. a non-unitary formulation) comprising at least        one of the two or more materials/agents together with        instructions for combination therapy with the two or more        materials/agents;    -   material comprising at least one of the two or more        materials/agents together with instructions for administration        to a patient population in which the other(s) of the two or more        materials/agents have been (or are being) administered;    -   material comprising at least one of the two or more        materials/agents in an amount or in a form which is specifically        adapted for use in combination with the other(s) of the two or        more materials/agents.

As used herein, the term “combination therapy” is intended to definetherapies which comprise the use of a combination of two or morematerials/agents (as defined above). Thus, references to “combinationtherapy”, “combinations” and the use of materials/agents “incombination” in this application may refer to materials/agents that areadministered as part of the same overall treatment regimen. As such, theposology of each of the two or more materials/agents may differ: eachmay be administered at the same time or at different times. It willtherefore be appreciated that the materials/agents of the combinationmay be administered sequentially (e.g. before or after) orsimultaneously, either in the same pharmaceutical formulation (i.e.together), or in different pharmaceutical formulations (i.e.separately). Simultaneously in the same formulation is as a unitaryformulation whereas simultaneously in different pharmaceuticalformulations is non-unitary. The posologies of each of the two or morematerials/agents in a combination therapy may also differ with respectto the route of administration.

“Concomitantly” means administering two or more materials/agents to asubject in a manner that is correlated in time, preferably sufficientlycorrelated in time so as to provide a modulation in a physiologic orimmunologic response, and even more preferably the two or morematerials/agents are administered in combination. In embodiments,concomitant administration may encompass administration of two or morematerials/agents within a specified period of time, preferably within 1month, more preferably within 1 week, still more preferably within 1day, and even more preferably within 1 hour. In embodiments, thematerials/agents may be repeatedly administered concomitantly; that isconcomitant administration on more than one occasion, as may be providedin the Examples.

“Determining” or “determine” means to ascertain a factual relationship.Determining may be accomplished in a number of ways, including but notlimited to performing experiments, or making projections. For instance,a dose of an immunosuppressant or antigen may be determined by startingwith a test dose and using known scaling techniques (such as allometricor isometric scaling) to determine the dose for administration. Such mayalso be used to determine a protocol as provided herein. In anotherembodiment, the dose may be determined by testing various doses in asubject, i.e. through direct experimentation based on experience andguiding data. In embodiments, “determining” or “determine” comprises“causing to be determined.” “Causing to be determined” means causing,urging, encouraging, aiding, inducing or directing or acting incoordination with an entity for the entity to ascertain a factualrelationship; including directly or indirectly, or expressly orimpliedly.

“Dosage form” means a pharmacologically and/or immunologically activematerial in a medium, carrier, vehicle, or device suitable foradministration to a subject. Any one of the compositions or dosesprovided herein may be in a dosage form.

“Dose” refers to a specific quantity of a pharmacologically and/orimmunologically active material for administration to a subject for agiven time.

“Encapsulate” means to enclose at least a portion of a substance withina synthetic nanocarrier. In some embodiments, a substance is enclosedcompletely within a synthetic nanocarrier. In other embodiments, most orall of a substance that is encapsulated is not exposed to the localenvironment external to the synthetic nanocarrier. In other embodiments,no more than 50%, 40%, 30%, 20%, 10% or 5% (weight/weight) is exposed tothe local environment. Encapsulation is distinct from absorption, whichplaces most or all of a substance on a surface of a syntheticnanocarrier, and leaves the substance exposed to the local environmentexternal to the synthetic nanocarrier.

“Generating” means causing an action, such as a physiologic orimmunologic response (e.g., a tolerogenic immune response) to occur,either directly oneself or indirectly.

“Identifying a subject” is any action or set of actions that allows aclinician to recognize a subject as one who may benefit from themethods, compositions or kits provided herein. Preferably, theidentified subject is one who is in need of therapeutic benefit from anon-allergenic antigen as provided herein. The action or set of actionsmay be either directly oneself or indirectly. In one embodiment of anyone of the methods provided herein, the method further comprisesidentifying a subject in need of a method, composition or kit asprovided herein.

“Immunosuppressant” means a compound that causes an APC to have animmunosuppressive effect (e.g., tolerogenic effect) or a T cell or a Bcell to be suppressed. An immunosuppressive effect generally refers tothe production or expression of cytokines or other factors by the APCthat reduces, inhibits or prevents an undesired immune response or thatpromotes a desired immune response, such as a regulatory immuneresponse. When the APC acquires an immunosuppressive function (under theimmunosuppressive effect) on immune cells that recognize an antigenpresented by this APC, the immunosuppressive effect is said to bespecific to the presented antigen. Without being bound by any particulartheory, it is thought that the immunosuppressive effect is a result ofthe immunosuppressant being delivered to the APC, preferably in thepresence of an antigen. In one embodiment, the immunosuppressant is onethat causes an APC to promote a regulatory phenotype in one or moreimmune effector cells. For example, the regulatory phenotype may becharacterized by the inhibition of the production, induction,stimulation or recruitment of antigen-specific CD4+ T cells or B cells,the inhibition of the production of antigen-specific antibodies, theproduction, induction, stimulation or recruitment of Treg cells (e.g.,CD4+CD25highFoxP3+ Treg cells), etc. This may be the result of theconversion of CD4+ T cells or B cells to a regulatory phenotype. Thismay also be the result of induction of FoxP3 in other immune cells, suchas CD8+ T cells, macrophages and iNKT cells. In one embodiment, theimmunosuppressant is one that affects the response of the APC after itprocesses an antigen. In another embodiment, the immunosuppressant isnot one that interferes with the processing of the antigen. In a furtherembodiment, the immunosuppressant is not an apoptotic-signalingmolecule. In another embodiment, the immunosuppressant is not aphospholipid.

Immunosuppressants include, but are not limited to, statins; mTORinhibitors, such as rapamycin or a rapamycin analog; TGF-β signalingagents; TGF-β receptor agonists; histone deacetylase inhibitors, such asTrichostatin A; corticosteroids; inhibitors of mitochondrial function,such as rotenone; P38 inhibitors; NF-κβ inhibitors, such as 6Bio,Dexamethasone, TCPA-1, IKK VII; adenosine receptor agonists;prostaglandin E2 agonists (PGE2), such as Misoprostol; phosphodiesteraseinhibitors, such as phosphodiesterase 4 inhibitor (PDE4), such asRolipram; proteasome inhibitors; kinase inhibitors; G-protein coupledreceptor agonists; G-protein coupled receptor antagonists;glucocorticoids; retinoids; cytokine inhibitors; cytokine receptorinhibitors; cytokine receptor activators; peroxisomeproliferator-activated receptor antagonists; peroxisomeproliferator-activated receptor agonists; histone deacetylaseinhibitors; calcineurin inhibitors; phosphatase inhibitors; PI3 KBinhibitors, such as TGX-221; autophagy inhibitors, such as3-Methyladenine; aryl hydrocarbon receptor inhibitors; proteasomeinhibitor I (PSI); and oxidized ATPs, such as P2X receptor blockers.Immunosuppressants also include IDO, vitamin D3, cyclosporins, such ascyclosporine A, aryl hydrocarbon receptor inhibitors, resveratrol,azathiopurine (Aza), 6-mercaptopurine (6-MP), 6-thioguanine (6-TG),FK506, sanglifehrin A, salmeterol, mycophenolate mofetil (MMF), aspirinand other COX inhibitors, niflumic acid, estriol, methotrexate andtriptolide. In embodiments, the immunosuppressant may comprise any ofthe agents provided herein.

The immunosuppressant can be a compound that directly provides theimmunosuppressive effect on APCs or it can be a compound that providesthe immunosuppressive effect indirectly (i.e., after being processed insome way after administration). Immunosuppressants, therefore, includeprodrug forms of any of the compounds provided herein.

In embodiments of any one of the methods, compositions or kits providedherein, the immunosuppressants provided herein are attached to syntheticnanocarriers. In preferable embodiments, the immunosuppressant is anelement that is in addition to the material that makes up the structureof the synthetic nanocarrier. For example, in one embodiment, where thesynthetic nanocarrier is made up of one or more polymers, theimmunosuppressant is a compound that is in addition and attached to theone or more polymers. As another example, in one embodiment, where thesynthetic nanocarrier is made up of one or more lipids, theimmunosuppressant is again in addition and attached to the one or morelipids. In embodiments, such as where the material of the syntheticnanocarrier also results in an immunosuppressive effect, theimmunosuppressant is an element present in addition to the material ofthe synthetic nanocarrier that results in an immunosuppressive effect.

Other exemplary immunosuppressants include, but are not limited, smallmolecule drugs, natural products, antibodies (e.g., antibodies againstCD20, CD3, CD4), biologics-based drugs, carbohydrate-based drugs,nanoparticles, liposomes, RNAi, antisense nucleic acids, aptamers,methotrexate, NSAIDs; fingolimod; natalizumab; alemtuzumab; anti-CD3;tacrolimus (FK506); cytokines and growth factors, such as TGF-β andIL-10; etc. Further immunosuppressants, are known to those of skill inthe art, and the invention is not limited in this respect.

In embodiments of any one of the methods, compositions or kits providedherein, the immunosuppressant is in a form, such as a nanocrystallineform, whereby the form of the immunosuppressant itself is a particle orparticle-like. In embodiments, such forms mimic a virus or other foreignpathogen. Many drugs have been nanonized and appropriate methods forproducing such drug forms would be known to one of ordinary skill in theart. Drug nanocrystals, such as nanocrystalline rapamycin are known tothose of ordinary skill in the art (Katteboinaa, et al. 2009,International Journal of PharmTech Resesarch; Vol. 1, No. 3; pp 682-694.As used herein a “drug nanocrystal” refers to a form of a drug (e.g., animmunosuppressant) that does not include a carrier or matrix material.In some embodiments, drug nanocrystals comprise 90%, 95%, 98%, or 99% ormore drug. Methods for producing drug nanocrystals include, withoutlimitation, milling, high pressure homogenization, precipitation, spraydrying, rapid expansion of supercritical solution (RESS), Nanoedge®technology (Baxter Healthcare), and Nanocrystal Technology™ (ElanCorporation). In some embodiments, a surfactant or a stabilizer may beused for steric or electrostatic stability of the drug nanocrystal. Insome embodiments the nanocrystal or nanocrytalline form of animmunosuppressant may be used to increase the solubility, stability,and/or bioavailability of the immunosuppressant, particularlyimmunosuppressants that are insoluble or labile. In some embodiments, ananaphylactic reaction to a non-allergenic antigen is reduced orprevented to a comparable extent following administering a non-allergicantigen concomitantly with an immunosuppressant in nanocrystalline formas achieved following administration of a non-allergenic antigenconcomitantly with a composition comprising synthetic nanocarriersattached to an immunosuppressant.

“Load” of the immunosuppressant, when attached to a syntheticnanocarrier, is the amount of the immunosuppressant attached to asynthetic nanocarrier based on the total dry recipe weight of materialsin an entire synthetic nanocarrier (weight/weight). Generally, such aload is calculated as an average across a population of syntheticnanocarriers. In one embodiment, the load of the immunosuppressant onaverage across a population of synthetic nanocarriers is between 0.0001%and 99%. In another embodiment, the load of the immunosuppressant isbetween 0.01% and 50%. In another embodiment, the load of theimmunosuppressant is between 0.01% and 20%. In a further embodiment, theload of the immunosuppressant is between 0.1% and 10%. In still afurther embodiment, the load of the immunosuppressant is between 1% and10%. In still a further embodiment, the load is between 7% and 20%. Inyet another embodiment, the load of the immunosuppressant is at least0.1%, at least 0.2%, at least 0.3%, at least 0.4%, at least 0.5%, atleast 0.6%, at least 0.7%, at least 0.8%, at least 0.9%, at least 1%, atleast 2%, at least 3%, at least 4%, at least 5%, at least 6%, at leastat least 7%, at least 8%, at least 9%, at least 10%, at least 11%, atleast 12%, at least 13%, at least 14%, at least 15%, at least 16%, atleast 17%, at least 18%, at least 19% at least 20%, at least 25%, atleast 30%, at least 40%, at least 50%, at least 60%, at least 70%, atleast 80%, at least 90%, at least 95%, at least 96%, at least 97%, atleast 98% or at least 99% on average across the population of syntheticnanocarriers. In yet a further embodiment, the load of theimmunosuppressant is 0.1%, 0.2%, 0.3%, 0.4%, 0.5%, 0.6%, 0.7%, 0.8%,0.9%, 1%, 2%, 3%, 4%, 5%, 6%, 7%, 8%, 9%, 10%, 11%, 12%, 13%, 14%, 15%,16%, 17%, 18%, 19% or 20% on average across the population of syntheticnanocarriers. In some embodiments of the above embodiments, the load ofthe immunosuppressant is no more than 25% on average across a populationof synthetic nanocarriers. In embodiments, the load is calculated as maybe described in the Examples or as otherwise known in the art.

In some embodiments, when the form of the immunosuppressant is itself aparticle or particle-like, such as a nanocrystalline immunosuppressant,the load of immunosuppressant is the amount of the immunosuppressant inthe particles or the like (weight/weight). In such embodiments, the loadcan approach 97%, 98%, 99% or more.

“Maximum dimension of a synthetic nanocarrier” means the largestdimension of a nanocarrier measured along any axis of the syntheticnanocarrier. “Minimum dimension of a synthetic nanocarrier” means thesmallest dimension of a synthetic nanocarrier measured along any axis ofthe synthetic nanocarrier. For example, for a spheroidal syntheticnanocarrier, the maximum and minimum dimension of a syntheticnanocarrier would be substantially identical, and would be the size ofits diameter. Similarly, for a cuboidal synthetic nanocarrier, theminimum dimension of a synthetic nanocarrier would be the smallest ofits height, width or length, while the maximum dimension of a syntheticnanocarrier would be the largest of its height, width or length. In anembodiment, a minimum dimension of at least 75%, preferably at least80%, more preferably at least 90%, of the synthetic nanocarriers in asample, based on the total number of synthetic nanocarriers in thesample, is equal to or greater than 100 nm. In an embodiment, a maximumdimension of at least 75%, preferably at least 80%, more preferably atleast 90%, of the synthetic nanocarriers in a sample, based on the totalnumber of synthetic nanocarriers in the sample, is equal to or less than5 μm. Preferably, a minimum dimension of at least 75%, preferably atleast 80%, more preferably at least 90%, of the synthetic nanocarriersin a sample, based on the total number of synthetic nanocarriers in thesample, is greater than 110 nm, more preferably greater than 120 nm,more preferably greater than 130 nm, and more preferably still greaterthan 150 nm. Aspects ratios of the maximum and minimum dimensions ofsynthetic nanocarriers may vary depending on the embodiment. Forinstance, aspect ratios of the maximum to minimum dimensions of thesynthetic nanocarriers may vary from 1:1 to 1,000, 000:1, preferablyfrom 1:1 to 100, 000:1, more preferably from 1:1 to 10,000:1, morepreferably from 1:1 to 1000:1, still more preferably from 1:1 to 100:1,and yet more preferably from 1:1 to 10:1. Preferably, a maximumdimension of at least 75%, preferably at least 80%, more preferably atleast 90%, of the synthetic nanocarriers in a sample, based on the totalnumber of synthetic nanocarriers in the sample is equal to or less than3 μm, more preferably equal to or less than 2 μm, more preferably equalto or less than 1 μm, more preferably equal to or less than 800 nm, morepreferably equal to or less than 600 nm, and more preferably still equalto or less than 500 nm. In preferred embodiments, a minimum dimension ofat least 75%, preferably at least 80%, more preferably at least 90%, ofthe synthetic nanocarriers in a sample, based on the total number ofsynthetic nanocarriers in the sample, is equal to or greater than 100nm, more preferably equal to or greater than 120 nm, more preferablyequal to or greater than 130 nm, more preferably equal to or greaterthan 140 nm, and more preferably still equal to or greater than 150 nm.Measurement of synthetic nanocarrier dimensions (e.g., effectivediameter) may be obtained, in some embodiments, by suspending thesynthetic nanocarriers in a liquid (usually aqueous) media and usingdynamic light scattering (DLS) (e.g. using a Brookhaven ZetaPALSinstrument). For example, a suspension of synthetic nanocarriers can bediluted from an aqueous buffer into purified water to achieve a finalsynthetic nanocarrier suspension concentration of approximately 0.01 to0.1 mg/mL. The diluted suspension may be prepared directly inside, ortransferred to, a suitable cuvette for DLS analysis. The cuvette maythen be placed in the DLS, allowed to equilibrate to the controlledtemperature, and then scanned for sufficient time to acquire a stableand reproducible distribution based on appropriate inputs for viscosityof the medium and refractive indicies of the sample. The effectivediameter, or mean of the distribution, is then reported. Determining theeffective sizes of high aspect ratio, or non-spheroidal, syntheticnanocarriers may require augmentative techniques, such as electronmicroscopy, to obtain more accurate measurements. “Dimension” or “size”or “diameter” of synthetic nanocarriers means the mean of a particlesize distribution, for example, obtained using dynamic light scattering.

A “non-allergenic antigen” means an antigen that induces non-allergicimmune responses and/or would not be considered likely to result in anallergic response. Non-allergenic antigens can result in an anaphylaticor anaphylactoid response and such a response is characterized, in someembodiments, by production of primarily non-IgE antigen-specificantibodies, such as antigen-specific IgG antibodies. Such anaphylatic oranaphylactoid responses may result in the production of antigen-specificIgE antibodies but the production of such antibodies is not the primaryresponse and/or is less than the production of non-IgE antibodies.Accordingly, in some embodiments, a non-allergenic antigen is one thatcan cause an anaphylactic response or anaphylactoid response generallycharacterized by one or more (or all) of the following: the presence ofor increased concentration of antigen-specific IgG antibodies (such asIgG1 antibodies); the absence of or reduced concentration ofantigen-specific IgE antibodies; presence of IgG immune complexes;decreased expression of FcγRIII, for example on neutrophils and/orbasophils; increased concentration of platelet activating factor (PAF),for example, by macrophages and/or basophils, and the like. In someembodiments, such anaphylactic responses can be monitored by assessingthe quantity and/or specificity of antibodies; expression of FcγRIII;detection of IgG immune complexes, vasoactive mediators; cutaneousinflammation or irritation (e.g., a rash, hives, etc.), inflammation orswolling of mucosal tissues, respiratory compromise, organ dysfunction,gastrointestinal symptoms, measuring vascular permeability, smoothmuscle contraction, cardiac output, or temperature. In some embodiments,a non-allergenic antigen comprises a non-allergenic therapeuticmacromolecule or fragment or derivative thereof.

“Non-methoxy-terminated polymer” means a polymer that has at least oneterminus that ends with a moiety other than methoxy. In someembodiments, the polymer has at least two termini that ends with amoiety other than methoxy. In other embodiments, the polymer has notermini that ends with methoxy. “Non-methoxy-terminated, pluronicpolymer” means a polymer other than a linear pluronic polymer withmethoxy at both termini. Polymeric nanoparticles as provided herein cancomprise non-methoxy-terminated polymers or non-methoxy-terminated,pluronic polymers.

“Pharmaceutically acceptable excipient” or “pharmaceutically acceptablecarrier” means a pharmacologically inactive material used together witha pharmacologically active material to formulate the compositions.Pharmaceutically acceptable excipients comprise a variety of materialsknown in the art, including but not limited to saccharides (such asglucose, lactose, and the like), preservatives such as antimicrobialagents, reconstitution aids, colorants, saline (such as phosphatebuffered saline), and buffers.

“Protocol” means a pattern of administering to a subject and includesany dosing regimen of one or more substances to a subject. Protocols aremade up of elements (or variables); thus a protocol comprises one ormore elements. Such elements of the protocol can comprise dosingamounts, dosing frequency, routes of administration, dosing duration,dosing rates, interval between dosing, combinations of any of theforegoing, and the like. In some embodiments, such a protocol may beused to administer one or more compositions of the invention to one ormore test subjects. Immune responses in these test subjects can then beassessed to determine whether or not the protocol was effective ingenerating a desired or desired level of an immune response ortherapeutic effect. Any therapeutic and/or immunologic effect may beassessed. One or more of the elements of a protocol may have beenpreviously demonstrated in test subjects, such as non-human subjects,and then translated into human protocols. For example, dosing amountsdemonstrated in non-human subjects can be scaled as an element of ahuman protocol using established techniques such as alimetric scaling orother scaling methods. Whether or not a protocol had a desired effectcan be determined using any of the methods provided herein or otherwiseknown in the art. For example, a sample may be obtained from a subjectto which a composition provided herein has been administered accordingto a specific protocol in order to determine whether or not specificimmune cells, cytokines, antibodies, etc. were reduced, generated,activated, etc. Useful methods for detecting the presence and/or numberof immune cells include, but are not limited to, flow cytometric methods(e.g., FACS), ELISpot, proliferation responses, cytokine production, andimmunohistochemistry methods. Antibodies and other binding agents forspecific staining of immune cell markers, are commercially available.Such kits typically include staining reagents for antigens that allowfor FACS-based detection, separation and/or quantitation of a desiredcell population from a heterogeneous population of cells. Inembodiments, a number of compositions as provided herein areadministered to another subject using one or more or all orsubstantially all of the elements of which the protocol is comprised.

“Providing” means an action or set of actions that an individualperforms that supply a needed item or set of items or methods forpracticing of the present invention. The action or set of actions may betaken either directly oneself or indirectly.

“Providing a subject” is any action or set of actions that causes aclinician to come in contact with a subject and administer a compositionprovided herein thereto or to perform a method provided hereinthereupon. Preferably, the subject is one who is in need ofantigen-specific tolerance or reduction or prevention of anaphylaxis toa non-allergenic antigen. The action or set of actions may be takeneither directly oneself or indirectly. In one embodiment of any one ofthe methods provided herein, the method further comprises providing asubject.

“Recording” means noting, or causing directly or indirectly activitiesin the expectation that such noting would take place, in any written orelectronic form, that a method or composition provided herein achieved areduction in or prevention of anaphylaxis to a non-allergenic antigen.In some embodiments, the recording occurs when an immunosuppressant incombination with a non-allergenic antigen are administered to a subjectaccording to a method provided herein or at some point thereafter.“Written form”, as used herein, refers to any recordation on a mediumsuch as paper. “Electronic form”, as used herein, refers to anyrecordation on electronic media. Any one of the methods provided hereincan further comprise a step of recording a reduction on prevention of ananaphylactic or anaphylactoid response to a non-allergenic antigen in asubject receiving a treatment according to a method provided herein.

“Subject” means animals, including warm blooded mammals such as humansand primates; avians; domestic household or farm animals such as cats,dogs, sheep, goats, cattle, horses and pigs; laboratory animals such asmice, rats and guinea pigs; fish; reptiles; zoo and wild animals; andthe like.

“Synthetic nanocarrier(s)” means a discrete object that is not found innature, and that possesses at least one dimension that is less than orequal to 5 microns in size. Albumin nanoparticles are generally includedas synthetic nanocarriers, however in certain embodiments the syntheticnanocarriers do not comprise albumin nanoparticles. In embodiments,synthetic nanocarriers do not comprise chitosan. In other embodiments,synthetic nanocarriers are not lipid-based nanoparticles. In furtherembodiments, synthetic nanocarriers do not comprise a phospholipid.

A synthetic nanocarrier can be, but is not limited to, one or aplurality of lipid-based nanoparticles (also referred to herein as lipidnanoparticles, i.e., nanoparticles where the majority of the materialthat makes up their structure are lipids), polymeric nanoparticles,metallic nanoparticles, surfactant-based emulsions, dendrimers,buckyballs, nanowires, virus-like particles (i.e., particles that areprimarily made up of viral structural proteins but that are notinfectious or have low infectivity), peptide or protein-based particles(also referred to herein as protein particles, i.e., particles where themajority of the material that makes up their structure are peptides orproteins) (such as albumin nanoparticles) and/or nanoparticles that aredeveloped using a combination of nanomaterials such as lipid-polymernanoparticles. Synthetic nanocarriers may be a variety of differentshapes, including but not limited to spheroidal, cuboidal, pyramidal,oblong, cylindrical, toroidal, and the like. Synthetic nanocarriersaccording to the invention comprise one or more surfaces. Exemplarysynthetic nanocarriers that can be adapted for use in the practice ofthe present invention comprise: (1) the biodegradable nanoparticlesdisclosed in U.S. Pat. No. 5,543,158 to Gref et al., (2) the polymericnanoparticles of Published US Patent Application 20060002852 to Saltzmanet al., (3) the lithographically constructed nanoparticles of PublishedUS Patent Application 20090028910 to DeSimone et al., (4) the disclosureof WO 2009/051837 to von Andrian et al., (5) the nanoparticles disclosedin Published US Patent Application 2008/0145441 to Penades et al., (6)the protein nanoparticles disclosed in Published US Patent Application20090226525 to de los Rios et al., (7) the virus-like particlesdisclosed in published US Patent Application 20060222652 to Sebbel etal., (8) the nucleic acid attached virus-like particles disclosed inpublished US Patent Application 20060251677 to Bachmann et al., (9) thevirus-like particles disclosed in WO2010047839A1 or WO2009106999A2, (10)the nanoprecipitated nanoparticles disclosed in P. Paolicelli et al.,“Surface-modified PLGA-based Nanoparticles that can EfficientlyAssociate and Deliver Virus-like Particles” Nanomedicine. 5(6):843-853(2010), (11) apoptotic cells, apoptotic bodies or the synthetic orsemisynthetic mimics disclosed in U.S. Publication 2002/0086049, or (12)those of Look et al., Nanogel-based delivery of mycophenolic acidameliorates systemic lupus erythematosus in mice” J. ClinicalInvestigation 123(4):1741-1749 (2013). In embodiments, syntheticnanocarriers may possess an aspect ratio greater than 1:1, 1:1.2, 1:1.5,1:2, 1:3, 1:5, 1:7, or greater than 1:10.

Synthetic nanocarriers according to the invention that have a minimumdimension of equal to or less than about 100 nm, preferably equal to orless than 100 nm, do not comprise a surface with hydroxyl groups thatactivate complement or alternatively comprise a surface that consistsessentially of moieties that are not hydroxyl groups that activatecomplement. In a preferred embodiment, synthetic nanocarriers accordingto the invention that have a minimum dimension of equal to or less thanabout 100 nm, preferably equal to or less than 100 nm, do not comprise asurface that substantially activates complement or alternativelycomprise a surface that consists essentially of moieties that do notsubstantially activate complement. In a more preferred embodiment,synthetic nanocarriers according to the invention that have a minimumdimension of equal to or less than about 100 nm, preferably equal to orless than 100 nm, do not comprise a surface that activates complement oralternatively comprise a surface that consists essentially of moietiesthat do not activate complement. In embodiments, synthetic nanocarriersexclude virus-like particles. In embodiments, synthetic nanocarriers maypossess an aspect ratio greater than 1:1, 1:1.2, 1:1.5, 1:2, 1:3, 1:5,1:7, or greater than 1:10.

A “therapeutic macromolecule” refers to any protein, carbohydrate, lipidor nucleic acid that may be administered to a subject and have atherapeutic effect. In some embodiments, administration of thetherapeutic macromolecule to a subject may result in an undesired immuneresponse. As described herein, administration of a therapeuticmacromolecule as provided herein, in some embodiments, can enhance thetherapeutic effectiveness of the therapeutic macromolecule, such as byreducing undesired immune responses thereto. In some embodiments, thetherapeutic macromolecule may be a therapeutic polynucleotide ortherapeutic protein. As provided herein, the therapeutic macromoleculeis a non-allergenic therapeutic macromolecule.

“Therapeutic polynucleotide” means any polynucleotide orpolynucleotide-based therapy that may be administered to a subject andhave a therapeutic effect. Such therapies include gene silencing.Examples of such therapy are known in the art, and include, but are notlimited to, naked RNA (including messenger RNA, modified messenger RNA,and forms of RNAi). Examples of other therapeutic polynucleotides areprovided elsewhere herein. Therapeutic polynucleotides may be producedin, on or by cells and also may be obtained using cell free or fullysynthetic from in vitro methods. Subjects, therefore, include anysubject that is in need of treatment with any of the foregoing. Suchsubject include those that will receive any of the foregoing. Asprovided herein, the therapeutic polynucleotide is a non-allergenictherapeutic polynucleotide.

A “therapeutic protein” refers to any protein or protein-based therapythat may be administered to a subject and have a therapeutic effect.Such therapies include protein replacement and protein supplementationtherapies. Such therapies also include the administration of exogenousor foreign proteins, antibody therapies, and cell or cell-basedtherapies. Therapeutic proteins comprise, but are not limited to,enzymes, enzyme cofactors, hormones, blood clotting factors, cytokines,growth factors, monoclonal antibodies, antibody-drug conjugates, andpolyclonal antibodies. Examples of other therapeutic proteins areprovided elsewhere herein. Therapeutic proteins may be produced in, onor by cells and may be obtained from such cells or administered in theform of such cells. In embodiments, the therapeutic protein is producedin, on or by mammalian cells, insect cells, yeast cells, bacteria cells,plant cells, transgenic animal cells, transgenic plant cells, etc. Thetherapeutic protein may be recombinantly produced in such cells. Thetherapeutic protein may be produced in, on or by a virally transformedcell. Subjects, therefore, include any subject that is in need oftreatment with any of the foregoing. Such subject include those thatwill receive any of the foregoing. As provided herein, the therapeuticprotein is a non-allergenic therapeutic protein.

“Undesired immune response” refers to any undesired immune response thatresults from exposure to an antigen, promotes or exacerbates a disease,disorder or condition provided herein (or a symptom thereof), or issymptomatic of a disease, disorder or condition provided herein. Suchimmune responses generally have a negative impact on a subject's healthor is symptomatic of a negative impact on a subject's health. Undesiredimmune responses include anaphylaxis to a non-allergenic antigen.

C. Compositions and Methods

Provided herein are compositions comprising immunosuppressants, in someembodiments attached to synthetic nanocarriers, and related methods orkits. Such compositions, methods, or kits are useful for reducing thegeneration of undesired immune responses and promoting the generation oftolerogenic immune responses that are specific to non-allergenicantigens. The compositions can be administered to subjects in which atolerogenic immune response to a non-allergenic therapeuticmacromolecule is desired. Such subjects include those that are in needof therapy with the therapeutic macromolecule. In embodiments, multipledoses of the immunosuppressants are administered concomitantly asdescribed herein.

A wide variety of synthetic nanocarriers can be used according to theinvention. In some embodiments, synthetic nanocarriers are spheres orspheroids. In some embodiments, synthetic nanocarriers are flat orplate-shaped. In some embodiments, synthetic nanocarriers are cubes orcubic. In some embodiments, synthetic nanocarriers are ovals orellipses. In some embodiments, synthetic nanocarriers are cylinders,cones, or pyramids.

In some embodiments, it is desirable to use a population of syntheticnanocarriers that is relatively uniform in terms of size or shape sothat each synthetic nanocarrier has similar properties. For example, atleast 80%, at least 90%, or at least 95% of the synthetic nanocarriers,based on the total number of synthetic nanocarriers, may have a minimumdimension or maximum dimension that falls within 5%, 10%, or 20% of theaverage diameter or average dimension of the synthetic nanocarriers.

Synthetic nanocarriers can be solid or hollow and can comprise one ormore layers. In some embodiments, each layer has a unique compositionand unique properties relative to the other layer(s). To give but oneexample, synthetic nanocarriers may have a core/shell structure, whereinthe core is one layer (e.g. a polymeric core) and the shell is a secondlayer (e.g. a lipid bilayer or monolayer). Synthetic nanocarriers maycomprise a plurality of different layers.

In some embodiments, synthetic nanocarriers may optionally comprise oneor more lipids. In some embodiments, a synthetic nanocarrier maycomprise a liposome. In some embodiments, a synthetic nanocarrier maycomprise a lipid bilayer. In some embodiments, a synthetic nanocarriermay comprise a lipid monolayer. In some embodiments, a syntheticnanocarrier may comprise a micelle. In some embodiments, a syntheticnanocarrier may comprise a core comprising a polymeric matrix surroundedby a lipid layer (e.g., lipid bilayer, lipid monolayer, etc.). In someembodiments, a synthetic nanocarrier may comprise a non-polymeric core(e.g., metal particle, quantum dot, ceramic particle, bone particle,viral particle, proteins, nucleic acids, carbohydrates, etc.) surroundedby a lipid layer (e.g., lipid bilayer, lipid monolayer, etc.).

In other embodiments, synthetic nanocarriers may comprise metalparticles, quantum dots, ceramic particles, etc. In some embodiments, anon-polymeric synthetic nanocarrier is an aggregate of non-polymericcomponents, such as an aggregate of metal atoms (e.g., gold atoms).

In some embodiments, synthetic nanocarriers may optionally comprise oneor more amphiphilic entities. In some embodiments, an amphiphilic entitycan promote the production of synthetic nanocarriers with increasedstability, improved uniformity, or increased viscosity. In someembodiments, amphiphilic entities can be associated with the interiorsurface of a lipid membrane (e.g., lipid bilayer, lipid monolayer,etc.). Many amphiphilic entities known in the art are suitable for usein making synthetic nanocarriers in accordance with the presentinvention. Such amphiphilic entities include, but are not limited to,phosphoglycerides; phosphatidylcholines; dipalmitoyl phosphatidylcholine(DPPC); dioleylphosphatidyl ethanolamine (DOPE);dioleyloxypropyltriethylammonium (DOTMA); dioleoylphosphatidylcholine;cholesterol; cholesterol ester; diacylglycerol; diacylglycerolsuccinate;diphosphatidyl glycerol (DPPG); hexanedecanol; fatty alcohols such aspolyethylene glycol (PEG); polyoxyethylene-9-lauryl ether; a surfaceactive fatty acid, such as palmitic acid or oleic acid; fatty acids;fatty acid monoglycerides; fatty acid diglycerides; fatty acid amides;sorbitan trioleate (Span®85) glycocholate; sorbitan monolaurate(Span®20); polysorbate 20 (Tween®20); polysorbate 60 (Tween®60);polysorbate 65 (Tween®65); polysorbate 80 (Tween®80); polysorbate 85(Tween®85); polyoxyethylene monostearate; surfactin; a poloxomer; asorbitan fatty acid ester such as sorbitan trioleate; lecithin;lysolecithin; phosphatidylserine; phosphatidylinositol; sphingomyelin;phosphatidylethanolamine (cephalin); cardiolipin; phosphatidic acid;cerebrosides; dicetylphosphate; dipalmitoylphosphatidylglycerol;stearylamine; dodecylamine; hexadecyl-amine; acetyl palmitate; glycerolricinoleate; hexadecyl sterate; isopropyl myristate; tyloxapol;poly(ethylene glycol)5000-phosphatidylethanolamine; poly(ethyleneglycol)400-monostearate; phospholipids; synthetic and/or naturaldetergents having high surfactant properties; deoxycholates;cyclodextrins; chaotropic salts; ion pairing agents; and combinationsthereof. An amphiphilic entity component may be a mixture of differentamphiphilic entities. Those skilled in the art will recognize that thisis an exemplary, not comprehensive, list of substances with surfactantactivity. Any amphiphilic entity may be used in the production ofsynthetic nanocarriers to be used in accordance with the presentinvention.

In some embodiments, synthetic nanocarriers may optionally comprise oneor more carbohydrates. Carbohydrates may be natural or synthetic. Acarbohydrate may be a derivatized natural carbohydrate. In certainembodiments, a carbohydrate comprises monosaccharide or disaccharide,including but not limited to glucose, fructose, galactose, ribose,lactose, sucrose, maltose, trehalose, cellbiose, mannose, xylose,arabinose, glucoronic acid, galactoronic acid, mannuronic acid,glucosamine, galatosamine, and neuramic acid. In certain embodiments, acarbohydrate is a polysaccharide, including but not limited to pullulan,cellulose, microcrystalline cellulose, hydroxypropyl methylcellulose(HPMC), hydroxycellulose (HC), methylcellulose (MC), dextran,cyclodextran, glycogen, hydroxyethylstarch, carageenan, glycon, amylose,chitosan, N,O-carboxylmethylchitosan, algin and alginic acid, starch,chitin, inulin, konjac, glucommannan, pustulan, heparin, hyaluronicacid, curdlan, and xanthan. In embodiments, the synthetic nanocarriersdo not comprise (or specifically exclude) carbohydrates, such as apolysaccharide. In certain embodiments, the carbohydrate may comprise acarbohydrate derivative such as a sugar alcohol, including but notlimited to mannitol, sorbitol, xylitol, erythritol, maltitol, andlactitol.

In some embodiments, synthetic nanocarriers can comprise one or morepolymers. In some embodiments, the synthetic nanocarriers comprise oneor more polymers that is a non-methoxy-terminated, pluronic polymer. Insome embodiments, at least 1%, 2%, 3%, 4%, 5%, 10%, 15%, 20%, 25%, 30%,35%, 40%, 45%, 50%, 55%, 60%, 65%, 70%, 75%, 80%, 85%, 90%, 95%, 97%, or99% (weight/weight) of the polymers that make up the syntheticnanocarriers are non-methoxy-terminated, pluronic polymers. In someembodiments, all of the polymers that make up the synthetic nanocarriersare non-methoxy-terminated, pluronic polymers. In some embodiments, thesynthetic nanocarriers comprise one or more polymers that is anon-methoxy-terminated polymer. In some embodiments, at least 1%, 2%,3%, 4%, 5%, 10%, 15%, 20%, 25%, 30%, 35%, 40%, 45%, 50%, 55%, 60%, 65%,70%, 75%, 80%, 85%, 90%, 95%, 97%, or 99% (weight/weight) of thepolymers that make up the synthetic nanocarriers arenon-methoxy-terminated polymers. In some embodiments, all of thepolymers that make up the synthetic nanocarriers arenon-methoxy-terminated polymers. In some embodiments, the syntheticnanocarriers comprise one or more polymers that do not comprise pluronicpolymer. In some embodiments, at least 1%, 2%, 3%, 4%, 5%, 10%, 15%,20%, 25%, 30%, 35%, 40%, 45%, 50%, 55%, 60%, 65%, 70%, 75%, 80%, 85%,90%, 95%, 97%, or 99% (weight/weight) of the polymers that make up thesynthetic nanocarriers do not comprise pluronic polymer. In someembodiments, all of the polymers that make up the synthetic nanocarriersdo not comprise pluronic polymer. In some embodiments, such a polymercan be surrounded by a coating layer (e.g., liposome, lipid monolayer,micelle, etc.). In some embodiments, various elements of the syntheticnanocarriers can be attached to the polymer.

The immunosuppressants can be attached to the synthetic nanocarriers byany of a number of methods. Generally, the attaching can be a result ofbonding between the immunosuppressants and the synthetic nanocarriers.This bonding can result in the immunosuppressants being attached to thesurface of the synthetic nanocarriers and/or contained (encapsulated)within the synthetic nanocarriers. In some embodiments, however, theimmunosuppressants are encapsulated by the synthetic nanocarriers as aresult of the structure of the synthetic nanocarriers rather thanbonding to the synthetic nanocarriers. In preferable embodiments, thesynthetic nanocarrier comprises a polymer as provided herein, and theimmunosuppressants are attached to the polymer.

When attaching occurs as a result of bonding between theimmunosuppressants and synthetic nanocarriers, the attaching may occurvia a coupling moiety. A coupling moiety can be any moiety through whichan immunosuppressant is bonded to a synthetic nanocarrier. Such moietiesinclude covalent bonds, such as an amide bond or ester bond, as well asseparate molecules that bond (covalently or non-covalently) theimmunosuppressant to the synthetic nanocarrier. Such molecules includelinkers or polymers or a unit thereof. For example, the coupling moietycan comprise a charged polymer to which an immunosuppressantelectrostatically binds. As another example, the coupling moiety cancomprise a polymer or unit thereof to which it is covalently bonded.

In preferred embodiments, the synthetic nanocarriers comprise a polymeras provided herein. These synthetic nanocarriers can be completelypolymeric or they can be a mix of polymers and other materials.

In some embodiments, the polymers of a synthetic nanocarrier associateto form a polymeric matrix. In some of these embodiments, a component,such as an immunosuppressant, can be covalently associated with one ormore polymers of the polymeric matrix. In some embodiments, covalentassociation is mediated by a linker. In some embodiments, a componentcan be noncovalently associated with one or more polymers of thepolymeric matrix. For example, in some embodiments, a component can beencapsulated within, surrounded by, and/or dispersed throughout apolymeric matrix. Alternatively or additionally, a component can beassociated with one or more polymers of a polymeric matrix byhydrophobic interactions, charge interactions, van der Waals forces,etc. A wide variety of polymers and methods for forming polymericmatrices therefrom are known conventionally.

Polymers may be natural or unnatural (synthetic) polymers. Polymers maybe homopolymers or copolymers comprising two or more monomers. In termsof sequence, copolymers may be random, block, or comprise a combinationof random and block sequences. Typically, polymers in accordance withthe present invention are organic polymers.

In some embodiments, the polymer comprises a polyester, polycarbonate,polyamide, or polyether, or unit thereof. In other embodiments, thepolymer comprises poly(ethylene glycol) (PEG), polypropylene glycol,poly(lactic acid), poly(glycolic acid), poly(lactic-co-glycolic acid),or a polycaprolactone, or unit thereof. In some embodiments, it ispreferred that the polymer is biodegradable. Therefore, in theseembodiments, it is preferred that if the polymer comprises a polyether,such as poly(ethylene glycol) or polypropylene glycol or unit thereof,the polymer comprises a block-co-polymer of a polyether and abiodegradable polymer such that the polymer is biodegradable. In otherembodiments, the polymer does not solely comprise a polyether or unitthereof, such as poly(ethylene glycol) or polypropylene glycol or unitthereof.

Other examples of polymers suitable for use in the present inventioninclude, but are not limited to polyethylenes, polycarbonates (e.g.poly(1,3-dioxan-2one)), polyanhydrides (e.g. poly(sebacic anhydride)),polypropylfumerates, polyamides (e.g. polycaprolactam), polyacetals,polyethers, polyesters (e.g., polylactide, polyglycolide,polylactide-co-glycolide, polycaprolactone, polyhydroxyacid (e.g.poly(β-hydroxyalkanoate))), poly(orthoesters), polycyanoacrylates,polyvinyl alcohols, polyurethanes, polyphosphazenes, polyacrylates,polymethacrylates, polyureas, polystyrenes, and polyamines, polylysine,polylysine-PEG copolymers, and poly(ethyleneimine), poly(ethyleneimine)-PEG copolymers.

In some embodiments, polymers in accordance with the present inventioninclude polymers which have been approved for use in humans by the U.S.Food and Drug Administration (FDA) under 21 C.F.R. § 177.2600, includingbut not limited to polyesters (e.g., polylactic acid,poly(lactic-co-glycolic acid), polycaprolactone, polyvalerolactone,poly(1,3-dioxan-2one)); polyanhydrides (e.g., poly(sebacic anhydride));polyethers (e.g., polyethylene glycol); polyurethanes;polymethacrylates; polyacrylates; and polycyanoacrylates.

In some embodiments, polymers can be hydrophilic. For example, polymersmay comprise anionic groups (e.g., phosphate group, sulphate group,carboxylate group); cationic groups (e.g., quaternary amine group); orpolar groups (e.g., hydroxyl group, thiol group, amine group). In someembodiments, a synthetic nanocarrier comprising a hydrophilic polymericmatrix generates a hydrophilic environment within the syntheticnanocarrier. In some embodiments, polymers can be hydrophobic. In someembodiments, a synthetic nanocarrier comprising a hydrophobic polymericmatrix generates a hydrophobic environment within the syntheticnanocarrier. Selection of the hydrophilicity or hydrophobicity of thepolymer may have an impact on the nature of materials that areincorporated (e.g. attached) within the synthetic nanocarrier.

In some embodiments, polymers may be modified with one or more moietiesand/or functional groups. A variety of moieties or functional groups canbe used in accordance with the present invention. In some embodiments,polymers may be modified with polyethylene glycol (PEG), with acarbohydrate, and/or with acyclic polyacetals derived frompolysaccharides (Papisov, 2001, ACS Symposium Series, 786:301). Certainembodiments may be made using the general teachings of U.S. Pat. No.5,543,158 to Gref et al., or WO publication WO2009/051837 by Von Andrianet al.

In some embodiments, polymers may be modified with a lipid or fatty acidgroup. In some embodiments, a fatty acid group may be one or more ofbutyric, caproic, caprylic, capric, lauric, myristic, palmitic, stearic,arachidic, behenic, or lignoceric acid. In some embodiments, a fattyacid group may be one or more of palmitoleic, oleic, vaccenic, linoleic,alpha-linoleic, gamma-linoleic, arachidonic, gadoleic, arachidonic,eicosapentaenoic, docosahexaenoic, or erucic acid.

In some embodiments, polymers may be polyesters, including copolymerscomprising lactic acid and glycolic acid units, such as poly(lacticacid-co-glycolic acid) and poly(lactide-co-glycolide), collectivelyreferred to herein as “PLGA”; and homopolymers comprising glycolic acidunits, referred to herein as “PGA,” and lactic acid units, such aspoly-L-lactic acid, poly-D-lactic acid, poly-D,L-lactic acid,poly-L-lactide, poly-D-lactide, and poly-D,L-lactide, collectivelyreferred to herein as “PLA.” In some embodiments, exemplary polyestersinclude, for example, polyhydroxyacids; PEG copolymers and copolymers oflactide and glycolide (e.g., PLA-PEG copolymers, PGA-PEG copolymers,PLGA-PEG copolymers, and derivatives thereof. In some embodiments,polyesters include, for example, poly(caprolactone),poly(caprolactone)-PEG copolymers, poly(L-lactide-co-L-lysine),poly(serine ester), poly(4-hydroxy-L-proline ester),poly[α-(4-aminobutyl)-L-glycolic acid], and derivatives thereof.

In some embodiments, a polymer may be PLGA. PLGA is a biocompatible andbiodegradable co-polymer of lactic acid and glycolic acid, and variousforms of PLGA are characterized by the ratio of lactic acid:glycolicacid. Lactic acid can be L-lactic acid, D-lactic acid, or D,L-lacticacid. The degradation rate of PLGA can be adjusted by altering thelactic acid:glycolic acid ratio. In some embodiments, PLGA to be used inaccordance with the present invention is characterized by a lacticacid:glycolic acid ratio of approximately 85:15, approximately 75:25,approximately 60:40, approximately 50:50, approximately 40:60,approximately 25:75, or approximately 15:85.

In some embodiments, polymers may be one or more acrylic polymers. Incertain embodiments, acrylic polymers include, for example, acrylic acidand methacrylic acid copolymers, methyl methacrylate copolymers,ethoxyethyl methacrylates, cyanoethyl methacrylate, aminoalkylmethacrylate copolymer, poly(acrylic acid), poly(methacrylic acid),methacrylic acid alkylamide copolymer, poly(methyl methacrylate),poly(methacrylic acid anhydride), methyl methacrylate, polymethacrylate,poly(methyl methacrylate) copolymer, polyacrylamide, aminoalkylmethacrylate copolymer, glycidyl methacrylate copolymers,polycyanoacrylates, and combinations comprising one or more of theforegoing polymers. The acrylic polymer may comprise fully-polymerizedcopolymers of acrylic and methacrylic acid esters with a low content ofquaternary ammonium groups.

In some embodiments, polymers can be cationic polymers. In general,cationic polymers are able to condense and/or protect negatively chargedstrands of nucleic acids (Zauner et al., 1998, Adv. Drug Del. Rev.,30:97; and Kabanov et al., 1995, Bioconjugate Chem., 6:7), poly(ethyleneimine) (PEI; Boussif et al., 1995, Proc. Natl. Acad. Sci., USA, 1995,92:7297), and poly(amidoamine) dendrimers (Kukowska-Latallo et al.,1996, Proc. Natl. Acad. Sci., USA, 93:4897; Tang et al., 1996,Bioconjugate Chem., 7:703; and Haensler et al., 1993, BioconjugateChem., 4:372) are positively-charged at physiological pH, form ion pairswith nucleic acids. In embodiments, the synthetic nanocarriers may notcomprise (or may exclude) cationic polymers.

In some embodiments, polymers can be degradable polyesters bearingcationic side chains (Putnam et al., 1999, Macromolecules, 32:3658;Barrera et al., 1993, J. Am. Chem. Soc., 115:11010; Kwon et al., 1989,Macromolecules, 22:3250; Lim et al., 1999, J. Am. Chem. Soc., 121:5633;and Zhou et al., 1990, Macromolecules, 23:3399). Examples of thesepolyesters include poly(L-lactide-co-L-lysine) (Barrera et al., 1993, J.Am. Chem. Soc., 115:11010), poly(serine ester) (Zhou et al., 1990,Macromolecules, 23:3399), poly(4-hydroxy-L-proline ester) (Putnam etal., 1999, Macromolecules, 32:3658; and Lim et al., 1999, J. Am. Chem.Soc., 121:5633), and poly(4-hydroxy-L-proline ester) (Putnam et al.,1999, Macromolecules, 32:3658; and Lim et al., 1999, J. Am. Chem. Soc.,121:5633).

The properties of these and other polymers and methods for preparingthem are well known in the art (see, for example, U.S. Pat. Nos.6,123,727; 5,804,178; 5,770,417; 5,736,372; 5,716,404; 6,095,148;5,837,752; 5,902,599; 5,696,175; 5,514,378; 5,512,600; 5,399,665;5,019,379; 5,010,167; 4,806,621; 4,638,045; and 4,946,929; Wang et al.,2001, J. Am. Chem. Soc., 123:9480; Lim et al., 2001, J. Am. Chem. Soc.,123:2460; Langer, 2000, Acc. Chem. Res., 33:94; Langer, 1999, J.Control. Release, 62:7; and Uhrich et al., 1999, Chem. Rev., 99:3181).More generally, a variety of methods for synthesizing certain suitablepolymers are described in Concise Encyclopedia of Polymer Science andPolymeric Amines and Ammonium Salts, Ed. by Goethals, Pergamon Press,1980; Principles of Polymerization by Odian, John Wiley & Sons, FourthEdition, 2004; Contemporary Polymer Chemistry by Allcock et al.,Prentice-Hall, 1981; Deming et al., 1997, Nature, 390:386; and in U.S.Pat. Nos. 6,506,577, 6,632,922, 6,686,446, and 6,818,732.

In some embodiments, polymers can be linear or branched polymers. Insome embodiments, polymers can be dendrimers. In some embodiments,polymers can be substantially cross-linked to one another. In someembodiments, polymers can be substantially free of cross-links. In someembodiments, polymers can be used in accordance with the presentinvention without undergoing a cross-linking step. It is further to beunderstood that the synthetic nanocarriers may comprise blockcopolymers, graft copolymers, blends, mixtures, and/or adducts of any ofthe foregoing and other polymers. Those skilled in the art willrecognize that the polymers listed herein represent an exemplary, notcomprehensive, list of polymers that can be of use in accordance withthe present invention.

In some embodiments, synthetic nanocarriers do not comprise a polymericcomponent. In some embodiments, synthetic nanocarriers may comprisemetal particles, quantum dots, ceramic particles, etc. In someembodiments, a non-polymeric synthetic nanocarrier is an aggregate ofnon-polymeric components, such as an aggregate of metal atoms (e.g.,gold atoms).

Compositions according to the invention can comprise elements, such asimmunosuppressants, in combination with pharmaceutically acceptableexcipients, such as preservatives, buffers, saline, or phosphatebuffered saline. The compositions may be made using conventionalpharmaceutical manufacturing and compounding techniques to arrive atuseful dosage forms. In an embodiment, compositions, such as thosecomprising synthetic nanocarriers are suspended in sterile salinesolution for injection together with a preservative.

In embodiments, when preparing synthetic nanocarriers as carriers,methods for attaching components to the synthetic nanocarriers may beuseful. If the component is a small molecule it may be of advantage toattach the component to a polymer prior to the assembly of the syntheticnanocarriers. In embodiments, it may also be an advantage to prepare thesynthetic nanocarriers with surface groups that are used to attach thecomponent to the synthetic nanocarrier through the use of these surfacegroups rather than attaching the component to a polymer and then usingthis polymer conjugate in the construction of synthetic nanocarriers.

In certain embodiments, the coupling can be with a covalent linker. Inembodiments, immunosuppressants according to the invention can becovalently attached to the external surface via a 1,2,3-triazole linkerformed by the 1,3-dipolar cycloaddition reaction of azido groups on thesurface of the nanocarrier with immunosuppressant containing an alkynegroup or by the 1,3-dipolar cycloaddition reaction of alkynes on thesurface of the nanocarrier with immunosuppressants containing an azidogroup. Such cycloaddition reactions are preferably performed in thepresence of a Cu(I) catalyst along with a suitable Cu(I)-ligand and areducing agent to reduce Cu(II) compound to catalytic active Cu(I)compound. This Cu(I)-catalyzed azide-alkyne cycloaddition (CuAAC) canalso be referred as the click reaction.

Additionally, the covalent coupling may comprise a covalent linker thatcomprises an amide linker, a disulfide linker, a thioether linker, ahydrazone linker, a hydrazide linker, an imine or oxime linker, an ureaor thiourea linker, an amidine linker, an amine linker, and asulfonamide linker.

An amide linker is formed via an amide bond between an amine on onecomponent such as an immunosuppressant with the carboxylic acid group ofa second component such as the nanocarrier. The amide bond in the linkercan be made using any of the conventional amide bond forming reactionswith suitably protected amino acids and activated carboxylic acid suchN-hydroxysuccinimide-activated ester.

A disulfide linker is made via the formation of a disulfide (S—S) bondbetween two sulfur atoms of the form, for instance, of R1-S—S—R2. Adisulfide bond can be formed by thiol exchange of a component containingthiol/mercaptan group(—SH) with another activated thiol group on apolymer or nanocarrier or a nanocarrier containing thiol/mercaptangroups with a component containing activated thiol group.

A triazole linker, specifically a 1,2,3-triazole of the form

wherein R1 and R2 may be any chemical entities, is made by the1,3-dipolar cycloaddition reaction of an azide attached to a firstcomponent such as the nanocarrier with a terminal alkyne attached to asecond component such as the immunosuppressant. The 1,3-dipolarcycloaddition reaction is performed with or without a catalyst,preferably with Cu(I)-catalyst, which links the two components through a1,2,3-triazole function. This chemistry is described in detail bySharpless et al., Angew. Chem. Int. Ed. 41(14), 2596, (2002) and Meldal,et al, Chem. Rev., 2008, 108(8), 2952-3015 and is often referred to as a“click” reaction or CuAAC.

In embodiments, a polymer containing an azide or alkyne group, terminalto the polymer chain is prepared. This polymer is then used to prepare asynthetic nanocarrier in such a manner that a plurality of the alkyne orazide groups are positioned on the surface of that nanocarrier.Alternatively, the synthetic nanocarrier can be prepared by anotherroute, and subsequently functionalized with alkyne or azide groups. Thecomponent is prepared with the presence of either an alkyne (if thepolymer contains an azide) or an azide (if the polymer contains analkyne) group. The component is then allowed to react with thenanocarrier via the 1,3-dipolar cycloaddition reaction with or without acatalyst which covalently attaches the component to the particle throughthe 1,4-disubstituted 1,2,3-triazole linker.

A thioether linker is made by the formation of a sulfur-carbon(thioether) bond in the form, for instance, of R1-S—R2. Thioether can bemade by either alkylation of a thiol/mercaptan (—SH) group on onecomponent with an alkylating group such as halide or epoxide on a secondcomponent. Thioether linkers can also be formed by Michael addition of athiol/mercaptan group on one component to an electron-deficient alkenegroup on a second component containing a maleimide group or vinylsulfone group as the Michael acceptor. In another way, thioether linkerscan be prepared by the radical thiol-ene reaction of a thiol/mercaptangroup on one component with an alkene group on a second component.

A hydrazone linker is made by the reaction of a hydrazide group on onecomponent with an aldehyde/ketone group on the second component.

A hydrazide linker is formed by the reaction of a hydrazine group on onecomponent with a carboxylic acid group on the second component. Suchreaction is generally performed using chemistry similar to the formationof amide bond where the carboxylic acid is activated with an activatingreagent.

An imine or oxime linker is formed by the reaction of an amine orN-alkoxyamine (or aminooxy) group on one component with an aldehyde orketone group on the second component.

An urea or thiourea linker is prepared by the reaction of an amine groupon one component with an isocyanate or thioisocyanate group on thesecond component.

An amidine linker is prepared by the reaction of an amine group on onecomponent with an imidoester group on the second component.

An amine linker is made by the alkylation reaction of an amine group onone component with an alkylating group such as halide, epoxide, orsulfonate ester group on the second component. Alternatively, an aminelinker can also be made by reductive amination of an amine group on onecomponent with an aldehyde or ketone group on the second component witha suitable reducing reagent such as sodium cyanoborohydride or sodiumtriacetoxyborohydride.

A sulfonamide linker is made by the reaction of an amine group on onecomponent with a sulfonyl halide (such as sulfonyl chloride) group onthe second component.

A sulfone linker is made by Michael addition of a nucleophile to a vinylsulfone. Either the vinyl sulfone or the nucleophile may be on thesurface of the nanocarrier or attached to a component.

The component can also be conjugated to the nanocarrier via non-covalentconjugation methods. For example, a negative charged immunosuppressantcan be conjugated to a positive charged nanocarrier throughelectrostatic adsorption. A component containing a metal ligand can alsobe conjugated to a nanocarrier containing a metal complex via ametal-ligand complex.

In embodiments, the component can be attached to a polymer, for examplepolylactic acid-block-polyethylene glycol, prior to the assembly of thesynthetic nanocarrier or the synthetic nanocarrier can be formed withreactive or activatible groups on its surface. In the latter case, thecomponent may be prepared with a group which is compatible with theattachment chemistry that is presented by the synthetic nanocarriers'surface. In other embodiments, a peptide component can be attached toVLPs or liposomes using a suitable linker. A linker is a compound orreagent that is capable of coupling two molecules together. In anembodiment, the linker can be a homobifuntional or heterobifunctionalreagent as described in Hermanson 2008. For example, an VLP or liposomesynthetic nanocarrier containing a carboxylic group on the surface canbe treated with a homobifunctional linker, adipic dihydrazide (ADH), inthe presence of EDC to form the corresponding synthetic nanocarrier withthe ADH linker. The resulting ADH linked synthetic nanocarrier is thenconjugated with a peptide component containing an acid group via theother end of the ADH linker on nanocarrier to produce the correspondingVLP or liposome peptide conjugate.

For detailed descriptions of available conjugation methods, seeHermanson G T “Bioconjugate Techniques”, 2nd Edition Published byAcademic Press, Inc., 2008. In addition to covalent attachment thecomponent can be attached by adsorption to a pre-formed syntheticnanocarrier or it can be attached by encapsulation during the formationof the synthetic nanocarrier.

Any immunosuppressant as provided herein can be used in the methods orcompositions provided and can be, in some embodiments, attached tosynthetic nanocarriers. Immunosuppressants include, but are not limitedto, statins; mTOR inhibitors, such as rapamycin or a rapamycin analog;TGF-β signaling agents; TGF-β receptor agonists; histone deacetylase(HDAC) inhibitors; corticosteroids; inhibitors of mitochondrialfunction, such as rotenone; P38 inhibitors; NF-κβ inhibitors; adenosinereceptor agonists; prostaglandin E2 agonists; phosphodiesteraseinhibitors, such as phosphodiesterase 4 inhibitor; proteasomeinhibitors; kinase inhibitors; G-protein coupled receptor agonists;G-protein coupled receptor antagonists; glucocorticoids; retinoids;cytokine inhibitors; cytokine receptor inhibitors; cytokine receptoractivators; peroxisome proliferator-activated receptor antagonists;peroxisome proliferator-activated receptor agonists; histone deacetylaseinhibitors; calcineurin inhibitors; phosphatase inhibitors and oxidizedATPs. Immunosuppressants also include IDO, vitamin D3, cyclosporine A,aryl hydrocarbon receptor inhibitors, resveratrol, azathiopurine,6-mercaptopurine, aspirin, niflumic acid, estriol, tripolide,interleukins (e.g., IL-1, IL-10), cyclosporine A, siRNAs targetingcytokines or cytokine receptors and the like.

Examples of statins include atorvastatin (LIPITOR®, TORVAST®),cerivastatin, fluvastatin (LESCOL®, LESCOL® XL), lovastatin (MEVACOR®,ALTOCOR®, ALTOPREV®), mevastatin (COMPACTIN®), pitavastatin (LIVALO®,PIAVA®), rosuvastatin (PRAVACHOL®, SELEKTINE®, LIPOSTAT®), rosuvastatin(CRESTOR®), and simvastatin (ZOCOR®, LIPEX®).

Examples of mTOR inhibitors include rapamycin and analogs thereof (e.g.,CCL-779, RAD001, AP23573, C20-methallylrapamycin (C20-Marap),C16-(S)-butylsulfonamidorapamycin (C16-BSrap),C16-(S)-3-methylindolerapamycin (C16-iRap) (Bayle et al. Chemistry &Biology 2006, 13:99-107)), AZD8055, BEZ235 (NVP-BEZ235), chrysophanicacid (chrysophanol), deforolimus (MK-8669), everolimus (RAD0001),KU-0063794, PI-103, PP242, temsirolimus, and WYE-354 (available fromSelleck, Houston, Tex., USA).

Examples of TGF-β signaling agents include TGF-β ligands (e.g., activinA, GDF1, GDF11, bone morphogenic proteins, nodal, TGF-βs) and theirreceptors (e.g., ACVR1B, ACVR1c, ACVR2A, ACVR2B, BMPR2, BMPR1A, BMPR1B,TGFβRI, TGFβRII), R-SMADS/co-SMADS (e.g., SMAD1, SMAD2, SMAD3, SMAD4,SMAD5, SMAD8), and ligand inhibitors (e.g, follistatin, noggin, chordin,DAN, lefty, LTBP1, THBS1, Decorin).

Examples of inhibitors of mitochondrial function include atractyloside(dipotassium salt), bongkrekic acid (triammonium salt), carbonyl cyanidem-chlorophenylhydrazone, carboxyatractyloside (e.g., from Atractylisgummifera), CGP-37157, (−)-Deguelin (e.g., from Mundulea sericea), F16,hexokinase II VDAC binding domain peptide, oligomycin, rotenone, Ru360,SFK1, and valinomycin (e.g., from Streptomyces fulvissimus)(EMD4Biosciences, USA).

Examples of P38 inhibitors include SB-203580(4-(4-Fluorophenyl)-2-(4-methylsulfinylphenyl)-5-(4-pyridyl)1H-imidazole),SB-239063(trans-1-(4hydroxycyclohexyl)-4-(fluorophenyl)-5-(2-methoxy-pyrimidin-4-yl)imidazole),SB-220025(5-(2-amino-4-pyrimidinyl)-4-(4-fluorophenyl)-1-(4-piperidinyl)imidazole)),and ARRY-797. Examples of NF (e.g., NK-κβ) inhibitors includeIFRD1,2-(1,8-naphthyridin-2-yl)-Phenol, 5-aminosalicylic acid, BAY11-7082, BAY 11-7085, CAPE (Caffeic Acid Phenethylester),diethylmaleate, IKK-2 Inhibitor IV, IMD 0354, lactacystin, MG-132[Z-Leu-Leu-Leu-CHO], NFκB Activation Inhibitor III, NF-κB ActivationInhibitor II, JSH-23, parthenolide, Phenylarsine Oxide (PAO), PPM-18,pyrrolidinedithiocarbamic acid ammonium salt, QNZ, RO 106-9920,rocaglamide, rocaglamide AL, rocaglamide C, rocaglamide I, rocaglamideJ, rocaglaol, (R)-MG-132, sodium salicylate, triptolide (PG490), andwedelolactone.

Examples of adenosine receptor agonists include CGS-21680 and ATL-146e.

Examples of prostaglandin E2 agonists include E-Prostanoid 2 andE-Prostanoid 4.

Examples of phosphodiesterase inhibitors (non-selective and selectiveinhibitors) include caffeine, aminophylline, IBMX(3-isobutyl-1-methylxanthine), paraxanthine, pentoxifylline,theobromine, theophylline, methylated xanthines, vinpocetine, EHNA(erythro-9-(2-hydroxy-3-nonyl)adenine), anagrelide, enoximone (PERFAN™),milrinone, levosimendon, mesembrine, ibudilast, piclamilast, luteolin,drotaverine, roflumilast (DAXAS™, DALIRESP™), sildenafil (REVATION®,VIAGRA®), tadalafil (ADCIRCA®, CIALIS®), vardenafil (LEVITRA®, STAXYN®),udenafil, avanafil, icariin, 4-methylpiperazine, and pyrazolopyrimidin-7-1.

Examples of proteasome inhibitors include bortezomib, disulfuram,epigallocatechin-3-gallate, and salinosporamide A.

Examples of kinase inhibitors include bevacizumab, BIBW 2992, cetuximab(ERBITUX®), imatinib (GLEEVEC®), trastuzumab (HERCEPTIN®), gefitinib(IRESSA®), ranibizumab (LUCENTIS®), pegaptanib, sorafenib, dasatinib,sunitinib, erlotinib, nilotinib, lapatinib, panitumumab, vandetanib,E7080, pazopanib, and mubritinib.

Examples of glucocorticoids include hydrocortisone (cortisol), cortisoneacetate, prednisone, prednisolone, methylprednisolone, dexamethasone,betamethasone, triamcinolone, beclometasone, fludrocortisone acetate,deoxycorticosterone acetate (DOCA), and aldosterone.

Examples of retinoids include retinol, retinal, tretinoin (retinoicacid, RETIN-A®), isotretinoin (ACCUTANE®, AMNESTEEM®, CLARAVIS®,SOTRET®), alitretinoin (PANRETIN®), etretinate (TEGISON) and itsmetabolite acitretin (SORIATANE®), tazarotene (TAZORAC®, AVAGE®,ZORAC®), bexarotene (TARGRETIN®), and adapalene (DIFFERIN®).

Examples of cytokine inhibitors include IL1ra, IL1 receptor antagonist,IGFBP, TNF-BF, uromodulin, Alpha-2-Macroglobulin, Cyclosporin A,Pentamidine, and Pentoxifylline (PENTOPAK®, PENTOXIL®, TRENTAL®).

Examples of peroxisome proliferator-activated receptor antagonistsinclude GW9662, PPARy antagonist III, G335, and T0070907(EMD4Biosciences, USA).

Examples of peroxisome proliferator-activated receptor agonists includepioglitazone, ciglitazone, clofibrate, GW1929, GW7647, L-165,041, LY171883, PPARy activator, Fmoc-Leu, troglitazone, and WY-14643(EMD4Biosciences, USA).

Examples of histone deacetylase inhibitors include hydroxamic acids (orhydroxamates) such as trichostatin A, cyclic tetrapeptides (such astrapoxin B) and depsipeptides, benzamides, electrophilic ketones,aliphatic acid compounds such as phenylbutyrate and valproic acid,hydroxamic acids such as vorinostat (SAHA), belinostat (PXD101), LAQ824,and panobinostat (LBH589), benzamides such as entinostat (MS-275),CI994, and mocetinostat (MGCD0103), nicotinamide, derivatives of NAD,dihydrocoumarin, naphthopyranone, and 2-hydroxynaphaldehydes.

Examples of calcineurin inhibitors include cyclosporine, pimecrolimus,voclosporin, and tacrolimus.

Examples of phosphatase inhibitors include BN82002 hydrochloride,CP-91149, calyculin A, cantharidic acid, cantharidin, cypermethrin,ethyl-3,4-dephostatin, fostriecin sodium salt, MAZ51,methyl-3,4-dephostatin, NSC 95397, norcantharidin, okadaic acid ammoniumsalt from prorocentrum concavum, okadaic acid, okadaic acid potassiumsalt, okadaic acid sodium salt, phenylarsine oxide, various phosphataseinhibitor cocktails, protein phosphatase 1C, protein phosphatase 2Ainhibitor protein, protein phosphatase 2A1, protein phosphatase 2A2, andsodium orthovanadate.

The non-allergenic antigen may be delivered in the form of the antigenitself, or as fragments or derivatives thereof. Non-allergenic antigensinclude non-allergenic therapeutic macromolecules, such asnon-allergenic therapeutic proteins or non-allergenic therapeuticpolynucleotides.

Therapeutic proteins include, but are not limited to, infusibletherapeutic proteins, enzymes, enzyme cofactors, hormones, bloodclotting factors, cytokines and interferons, growth factors, monoclonalantibodies, and polyclonal antibodies (e.g., that are administered to asubject as a replacement therapy), and proteins associated with Pompe'sdisease (e.g., acid glucosidase alfa, rhGAA (e.g., Myozyme and Lumizyme(Genzyme)). Therapeutic proteins also include proteins involved in theblood coagulation cascade. Therapeutic proteins include, but are notlimited to, Factor VIII, Factor VII, Factor IX, Factor V, von WillebrandFactor, von Heldebrant Factor, tissue plasminogen activator, insulin,growth hormone, erythropoietin alfa, VEGF, thrombopoietin, lysozyme,antithrombin and the like. Therapeutic proteins also include adipokines,such as leptin and adiponectin. Other examples of therapeutic proteinsare as described below and elsewhere herein.

Examples of therapeutic proteins used in enzyme replacement therapy ofsubjects having a lysosomal storage disorder include, but are notlimited to, imiglucerase for the treatment of Gaucher's disease (e.g.,CEREZYME™), a-galactosidase A (a-gal A) for the treatment of Fabrydisease (e.g., agalsidase beta, FABRYZYME™), acid α-glucosidase (GAA)for the treatment of Pompe disease (e.g., acid glucosidase alfa,LUMIZYME™, MYOZYME™), arylsulfatase B for the treatment ofMucopolysaccharidoses (e.g., laronidase, ALDURAZYME™, idursulfase,ELAPRASE™, arylsulfatase B, NAGLAZYME™), pegloticase (KRYSTEXXA) andpegsiticase.

Examples of enzymes include oxidoreductases, transferases, hydrolases,lyases, isomerases, asparaginases, uricases, glycosidases,asparaginases, uricases, proteases, nucleases, collagenases,hyaluronidases, heparinases, heparanases, lysins, and ligases.

Therapeutic proteins may also include any enzyme, toxin, or otherprotein or peptide isolated or derived from a bacterial, fungal, orviral source.

Examples of hormones include Melatonin (N-acetyl-5-methoxytryptamine),Serotonin, Thyroxine (or tetraiodothyronine) (a thyroid hormone),Triiodothyronine (a thyroid hormone), Epinephrine (or adrenaline),Norepinephrine (or noradrenaline), Dopamine (or prolactin inhibitinghormone), Antimullerian hormone (or mullerian inhibiting factor orhormone), Adiponectin, Adrenocorticotropic hormone (or corticotropin),Angiotensinogen and angiotensin, Antidiuretic hormone (or vasopressin,arginine vasopressin), Atrial-natriuretic peptide (or atriopeptin),Calcitonin, Cholecystokinin, Corticotropin-releasing hormone,Erythropoietin, Follicle-stimulating hormone, Gastrin, Ghrelin,Glucagon, Glucagon-like peptide (GLP-1), GIP, Gonadotropin-releasinghormone, Growth hormone-releasing hormone, Human chorionic gonadotropin,Human placental lactogen, Growth hormone, Inhibin, Insulin, Insulin-likegrowth factor (or somatomedin), Leptin, Luteinizing hormone, Melanocytestimulating hormone, Orexin, Oxytocin, Parathyroid hormone, Prolactin,Relaxin, Secretin, Somatostatin, Thrombopoietin, Thyroid-stimulatinghormone (or thyrotropin), Thyrotropin-releasing hormone, Cortisol,Aldosterone, Testosterone, Dehydroepiandrosterone, Androstenedione,Dihydrotestosterone, Estradiol, Estrone, Estriol, Progesterone,Calcitriol (1,25-dihydroxyvitamin D3), Calcidiol (25-hydroxyvitamin D3),Prostaglandins, Leukotrienes, Prostacyclin, Thromboxane, Prolactinreleasing hormone, Lipotropin, Brain natriuretic peptide, NeuropeptideY, Histamine, Endothelin, Pancreatic polypeptide, Renin, and Enkephalin.

Examples of blood or blood coagulation factors include Factor I(fibrinogen), Factor II (prothrombin), tissue factor, Factor V(proaccelerin, labile factor), Factor VII (stable factor, proconvertin),Factor VIII (antihemophilic globulin), Factor IX (Christmas factor orplasma thromboplastin component), Factor X (Stuart-Prower factor),Factor Xa, Factor XI, Factor XII (Hageman factor), Factor XIII(fibrin-stabilizing factor), von Willebrand factor, prekallikrein(Fletcher factor), high-molecular weight kininogen (HMWK) (Fitzgeraldfactor), fibronectin, fibrin, thrombin, antithrombin III, heparincofactor II, protein C, protein S, protein Z, protein Z-related proteaseinhibitot (ZPI), plasminogen, alpha 2-antiplasmin, tissue plasminogenactivator (tPA), urokinase, plasminogen activator inhibitor-1 (PAI1),plasminogen activator inhibitor-2 (PAI2), cancer procoagulant, andepoetin alfa (Epogen, Procrit).

Examples of cytokines include lymphokines, interleukins, and chemokines,type 1 cytokines, such as IFN-γ, TGF-β, and type 2 cytokines, such asIL-4, IL-10, and IL-13.

Examples of growth factors include Adrenomedullin (AM), Angiopoietin(Ang), Autocrine motility factor, Bone morphogenetic proteins (BMPs),Brain-derived neurotrophic factor (BDNF), Epidermal growth factor (EGF),Erythropoietin (EPO), Fibroblast growth factor (FGF), Glial cellline-derived neurotrophic factor (GDNF), Granulocyte colony-stimulatingfactor (G-CSF), Granulocyte macrophage colony-stimulating factor(GM-CSF), Growth differentiation factor-9 (GDF9), Hepatocyte growthfactor (HGF), Hepatoma-derived growth factor (HDGF), Insulin-like growthfactor (IGF), Migration-stimulating factor, Myostatin (GDF-8), Nervegrowth factor (NGF) and other neurotrophins, Platelet-derived growthfactor (PDGF), Thrombopoietin (TPO), Transforming growth factoralpha(TGF-α), Transforming growth factor beta(TGF-β),Tumour_necrosis_factor-alpha(TNF-α), Vascular endothelial growth factor(VEGF), Wnt Signaling Pathway, placental growth factor (P1GF), (FoetalBovine Somatotrophin) (FBS), IL-1, IL-2, IL-3, IL-4, IL-5, IL-6, andIL-7.

Examples of monoclonal antibodies include Abagovomab, Abciximab,Adalimumab, Adecatumumab, Afelimomab, Afutuzumab, Alacizumab pegol, ALD,Alemtuzumab, Altumomab pentetate, Anatumomab mafenatox, Anrukinzumab,Anti-thymocyte globin, Apolizumab, Arcitumomab, Aselizumab, Atlizumab(tocilizumab), Atorolimumab, Bapineuzumab, Basiliximab, Bavituximab,Bectumomab, Belimumab, Benralizumab, Bertilimumab, Besilesomab,Bevacizumab, Biciromab, Bivatuzumab mertansine, Blinatumomab,Brentuximab vedotin, Briakinumab, Canakinumab, Cantuzumab mertansine,Capromab pendetide, Catumaxomab, Cedelizumab, Certolizumab pegol,Cetuximab, Citatuzumab bogatox, Cixutumumab, Clenoliximab, Clivatuzumabtetraxetan, Conatumumab, Dacetuzumab, Daclizumab, Daratumumab,Denosumab, Detumomab, Dorlimomab aritox, Dorlixizumab, Ecromeximab,Eculizumab, Edobacomab, Edrecolomab, Efalizumab, Efungumab, Elotuzumab,Elsilimomab, Enlimomab pegol, Epitumomab cituxetan, Epratuzumab,Erlizumab, Ertumaxomab, Etaracizumab, Exbivirumab, Fanolesomab,Faralimomab, Farletuzumab, Felvizumab, Fezakinumab, Figitumumab,Fontolizumab, Foravirumab, Fresolimumab, Galiximab, Gantenerumab,Gavilimomab, Gemtuzumab ozogamicin, GC1008, Girentuximab, Glembatumumabvedotin, Golimumab, Gomiliximab, Ibalizumab, Ibritumomab tiuxetan,Igovomab, Imciromab, Infliximab, Intetumumab, Inolimomab, Inotuzumabozogamicin, Ipilimumab, Iratumumab, Keliximab, Labetuzumab,Lebrikizumab, Lemalesomab, Lerdelimumab, Lexatumumab, Libivirumab,Lintuzumab, Lorvotuzumab mertansine, Lucatumumab, Lumiliximab,Mapatumumab, Maslimomab, Matuzumab, Mepolizumab, Metelimumab,Milatuzumab, Minretumomab, Mitumomab, Morolimumab, Motavizumab,Muromonab-CD3, Nacolomab tafenatox, Naptumomab estafenatox, Natalizumab,Nebacumab, Necitumumab, Nerelimomab, Nimotuzumab, Nofetumomab merpentan,Ocrelizumab, Odulimomab, Ofatumumab, Olaratumab, Omalizumab, Oportuzumabmonatox, Oregovomab, Otelixizumab, Pagibaximab, Palivizumab,Panitumumab, Panobacumab, Pascolizumab, Pemtumomab, Pertuzumab,Pexelizumab, Pintumomab, Priliximab, Pritumumab, Rafivirumab,Ramucirumab, Ranibizumab, Raxibacumab, Regavirumab Reslizumab,Rilotumumab, Rituximab, Robatumumab, Rontalizumab, Rovelizumab,Ruplizumab, Satumomab pendetide, Sevirumab, Sibrotuzumab, Sifalimumab,Siltuximab, Siplizumab, Solanezumab, Sonepcizumab, Sontuzumab,Stamulumab, Sulesomab, Tacatuzumab tetraxetan, Tadocizumab, Talizumab,Tanezumab, Taplitumomab paptox, Tefibazumab, Telimomab aritox,Tenatumomab, Teneliximab, Teplizumab, Ticilimumab (tremelimumab),Tigatuzumab, Tocilizumab (atlizumab), Toralizumab, Tositumomab,Trastuzumab, Tremelimumab, Tucotuzumab celmoleukin, Tuvirumab,Urtoxazumab, Ustekinumab, Vapaliximab, Vedolizumab, Veltuzumab,Vepalimomab, Visilizumab, Volociximab, Votumumab, Zalutumumab,Zanolimumab, Ziralimumab, and Zolimomab aritox. Monoclonal antibodiesfurther include anti-TNF-antibodies.

Examples of infusion therapy or injectable therapeutic proteins include,for example, Tocilizumab (Roche/Actemra®), alpha-1 antitrypsin(Kamada/AAT), Hematide® (Affymax and Takeda, synthetic peptide),albinterferon alfa-2b (Novartis/Zalbin™), Rhucin® (Pharming Group, C1inhibitor replacement therapy), tesamorelin (Theratechnologies/Egrifta,synthetic growth hormone-releasing factor), ocrelizumab (Genentech,Roche and Biogen), belimumab (GlaxoSmithKline/Benlysta®), pegloticase(Savient Pharmaceuticals/Krystexxa™), pegsiticase, taliglucerase alfa(Protalix/Uplyso), agalsidase alfa (Shire/Replagal®), velaglucerase alfa(Shire), and Keyhole Limpet Hemocyanin (KLH).

Additional therapeutic proteins include, for example, engineeredproteins, such as Fc fusion proteins, bispecific antibodies,multi-specific antibodies, nanobodies, antigen-binding proteins,antibody fragments, and protein conjugates, such as antibody drugconjugates.

Therapeutic polynucleotides include, but are not limited to nucleic acidaptamers such as Pegaptanib (Macugen, a pegylated anti-VEGF aptamer),antisense therapeutics such as antisense poly- or oligonucleotides(e.g., antiviral drug Fomivirsen, or Mipomersen, an antisensetherapeutic that targets the messenger RNA for apolipoprotein B forreduction of cholesterol level); small interfering RNAs (siRNAs) (e.g.,dicer substrate siRNA molecules (DsiRNAs) which are 25-30 base pairasymmetric double-stranded RNAs that mediate RNAi with extremely highpotency); or modified messenger RNAs (mmRNAs) such as those disclosed inUS Patent application 2013/0115272 to de Fougerolles et al. and inPublished US Patent application 2012/0251618 to Schrum et al.

Additional therapeutic macromolecules useful in accordance with aspectsof this invention will be apparent to those of skill in the art, and theinvention is not limited in this respect.

In some embodiments, a substance as provided herein, such as anon-allergenic antigen or immunosuppressant, may be isolated. Isolatedrefers to the element being separated from its native environment andpresent in sufficient quantities to permit its identification or use.This means, for example, the element may be (i) selectively produced byexpression cloning or (ii) purified as by chromatography orelectrophoresis. Isolated elements may be, but need not be,substantially pure. Because an isolated element may be admixed with apharmaceutically acceptable excipient in a pharmaceutical preparation,the element may comprise only a small percentage by weight of thepreparation. The element is nonetheless isolated in that it has beenseparated from the substances with which it may be associated in livingsystems, i.e., isolated from other lipids or proteins. Any of theelements provided herein may be isolated and included in thecompositions or used in the methods in isolated form.

D. Methods of Making and Using the Methods and Related Compositions

Aspects of the invention relate to determining a protocol for themethods of concomitant administration as provided herein. A protocol canbe determined by varying the frequency, dosage amount and other aspectsof administration of the non-allergenic antigen and the composition ofimmunosuppressant and subsequently assessing an anaphylactic reactionbased on such variation. A preferred protocol for practice of theinvention reduces or prevents anaphylaxis to a non-allergenic antigen.

Synthetic nanocarriers may be prepared using a wide variety of methodsknown in the art. For example, synthetic nanocarriers can be formed bymethods such as nanoprecipitation, flow focusing fluidic channels, spraydrying, single and double emulsion solvent evaporation, solventextraction, phase separation, milling, microemulsion procedures,microfabrication, nanofabrication, sacrificial layers, simple andcomplex coacervation, and other methods well known to those of ordinaryskill in the art. Alternatively or additionally, aqueous and organicsolvent syntheses for monodisperse semiconductor, conductive, magnetic,organic, and other nanomaterials have been described (Pellegrino et al.,2005, Small, 1:48; Murray et al., 2000, Ann. Rev. Mat. Sci., 30:545; andTrindade et al., 2001, Chem. Mat., 13:3843). Additional methods havebeen described in the literature (see, e.g., Doubrow, Ed.,“Microcapsules and Nanoparticles in Medicine and Pharmacy,” CRC Press,Boca Raton, 1992; Mathiowitz et al., 1987, J. Control. Release, 5:13;Mathiowitz et al., 1987, Reactive Polymers, 6:275; and Mathiowitz etal., 1988, J. Appl. Polymer Sci., 35:755; U.S. Pat. Nos. 5,578,325 and6,007,845; P. Paolicelli et al., “Surface-modified PLGA-basedNanoparticles that can Efficiently Associate and Deliver Virus-likeParticles” Nanomedicine. 5(6):843-853 (2010)).

Various materials may be encapsulated into synthetic nanocarriers asdesirable using a variety of methods including but not limited to C.Astete et al., “Synthesis and characterization of PLGA nanoparticles” J.Biomater. Sci. Polymer Edn, Vol. 17, No. 3, pp. 247-289 (2006); K.Avgoustakis “Pegylated Poly(Lactide) and Poly(Lactide-Co-Glycolide)Nanoparticles: Preparation, Properties and Possible Applications in DrugDelivery” Current Drug Delivery 1:321-333 (2004); C. Reis et al.,“Nanoencapsulation I. Methods for preparation of drug-loaded polymericnanoparticles” Nanomedicine 2:8-21 (2006); P. Paolicelli et al.,“Surface-modified PLGA-based Nanoparticles that can EfficientlyAssociate and Deliver Virus-like Particles” Nanomedicine. 5(6):843-853(2010). Other methods suitable for encapsulating materials intosynthetic nanocarriers may be used, including without limitation methodsdisclosed in U.S. Pat. No. 6,632,671 to Unger issued Oct. 14, 2003.

In certain embodiments, synthetic nanocarriers are prepared by ananoprecipitation process or spray drying. Conditions used in preparingsynthetic nanocarriers may be altered to yield particles of a desiredsize or property (e.g., hydrophobicity, hydrophilicity, externalmorphology, “stickiness,” shape, etc.). The method of preparing thesynthetic nanocarriers and the conditions (e.g., solvent, temperature,concentration, air flow rate, etc.) used may depend on the materials tobe attached to the synthetic nanocarriers and/or the composition of thepolymer matrix.

If synthetic nanocarriers prepared by any of the above methods have asize range outside of the desired range, such synthetic nanocarriers canbe sized, for example, using a sieve.

Elements (i.e., components) of the synthetic nanocarriers may beattached to the overall synthetic nanocarrier, e.g., by one or morecovalent bonds, or may be attached by means of one or more linkers.Additional methods of functionalizing synthetic nanocarriers may beadapted from Published US Patent Application 2006/0002852 to Saltzman etal., Published US Patent Application 2009/0028910 to DeSimone et al., orPublished International Patent Application WO/2008/127532 A1 to Murthyet al.

Alternatively or additionally, synthetic nanocarriers can be attached tocomponents directly or indirectly via non-covalent interactions. Innon-covalent embodiments, the non-covalent attaching is mediated bynon-covalent interactions including but not limited to chargeinteractions, affinity interactions, metal coordination, physicaladsorption, host-guest interactions, hydrophobic interactions, TTstacking interactions, hydrogen bonding interactions, van der Waalsinteractions, magnetic interactions, electrostatic interactions,dipole-dipole interactions, and/or combinations thereof. Suchattachments may be arranged to be on an external surface or an internalsurface of a synthetic nanocarrier. In embodiments, encapsulation and/orabsorption is a form of attaching. In embodiments, the syntheticnanocarriers can be combined with an antigen by admixing in the samevehicle or delivery system.

Compositions provided herein may comprise inorganic or organic buffers(e.g., sodium or potassium salts of phosphate, carbonate, acetate, orcitrate) and pH adjustment agents (e.g., hydrochloric acid, sodium orpotassium hydroxide, salts of citrate or acetate, amino acids and theirsalts) antioxidants (e.g., ascorbic acid, alpha-tocopherol), surfactants(e.g., polysorbate 20, polysorbate 80, polyoxyethylene9-10 nonyl phenol,sodium desoxycholate), solution and/or cryo/lyo stabilizers (e.g.,sucrose, lactose, mannitol, trehalose), osmotic adjustment agents (e.g.,salts or sugars), antibacterial agents (e.g., benzoic acid, phenol,gentamicin), antifoaming agents (e.g., polydimethylsilozone),preservatives (e.g., thimerosal, 2-phenoxyethanol, EDTA), polymericstabilizers and viscosity-adjustment agents (e.g., polyvinylpyrrolidone,poloxamer 488, carboxymethylcellulose) and co-solvents (e.g., glycerol,polyethylene glycol, ethanol).

Compositions according to the invention may comprise pharmaceuticallyacceptable excipients. The compositions may be made using conventionalpharmaceutical manufacturing and compounding techniques to arrive atuseful dosage forms. Techniques suitable for use in practicing thepresent invention may be found in Handbook of Industrial Mixing: Scienceand Practice, Edited by Edward L. Paul, Victor A. Atiemo-Obeng, andSuzanne M. Kresta, 2004 John Wiley & Sons, Inc.; and Pharmaceutics: TheScience of Dosage Form Design, 2nd Ed. Edited by M. E. Auten, 2001,Churchill Livingstone. In an embodiment, compositions are in a sterilesaline solution for injection together with a preservative.

It is to be understood that the compositions of the invention can bemade in any suitable manner, and the invention is in no way limited tocompositions that can be produced using the methods described herein.Selection of an appropriate method of manufacture may require attentionto the properties of the particular moieties being associated.

In some embodiments, compositions are manufactured under sterileconditions or are terminally sterilized. This can ensure that resultingcompositions are sterile and non-infectious, thus improving safety whencompared to non-sterile compositions. This provides a valuable safetymeasure, especially when subjects receiving the compositions have immunedefects, are suffering from infection, and/or are susceptible toinfection. In some embodiments, the compositions may be lyophilized andstored in suspension or as lyophilized powder depending on theformulation strategy for extended periods without losing activity.

Administration according to the present invention may be by a variety ofroutes, including but not limited to subcutaneous, intravenous,intraperitoneal, intramuscular, transmucosal, transdermal,transcutaneous or intradermal routes. In a preferred embodiment,administration is via a subcutaneous route of administration. Thecompositions referred to herein may be manufactured and prepared foradministration, preferably in some embodiments concomitantadministration, using conventional methods.

The compositions of the invention can be administered in effectiveamounts, such as the effective amounts described elsewhere herein. Dosesof dosage forms may contain varying amounts of populations of varyingamounts of immunosuppressants and/or non-allergenic antigens, accordingto the invention. The amount of immunosuppressants and/or non-allergenicantigens present in the inventive dosage forms can be varied accordingto the nature of the non-allergenic antigen, and/or immunosuppressants,the therapeutic benefit to be accomplished, whether or not theimmunsuppressants are attached to synthetic nanocarriers and other suchparameters. In embodiments, dose ranging studies can be conducted toestablish optimal therapeutic amount of the amount of immunosuppressantsand/or non-allergenic antigens to be present in dosage forms. Inembodiments, the immunosuppressants and/or non-allergenic antigens (whenadministered concomitantly) are present in dosage forms in an amounteffective to generate a tolerogenic immune response to thenon-allergenic antigens upon administration to a subject. Preferably theimmunosuppressive immune response is a reduction or prevention ofanaphylaxis to the non-allergenic antigen. It may be possible todetermine amounts of the immunosuppressants and/or non-allergenicantigens effective to generate a tolerogenic immune response usingconventional dose ranging studies and techniques in subjects. Inventivedosage forms may be administered at a variety of frequencies. In apreferred embodiment, a number of administrations are utilized to ensurea pharmacologically relevant response.

In some embodiments, administration of immunosuppressants withnon-allergenic antigens is undertaken e.g., prior to subsequent furtheradministration of the non-allergenic antigens. In exemplary embodiments,immunosuppressants are administered multiple times with concomitantadministration of non-allergenic antigen prior to subsequent furtheradministration of the non-allergenic antigen. In some embodiments, theimmunosuppressants are administered multiple times with concomitantadministration of non-allergenic antigen over a period of at least 7, 14or 21 days prior to subsequent further administration of thenon-allergenic antigen alone.

Another aspect of the disclosure relates to kits. In some embodiments,the kit comprises an immunosuppressant, in some embodiments attached tosynthetic nanocarriers, and a non-allergenic antigen. Theimmunosuppressant and non-allergenic antigen can be contained withinseparate containers or within the same container in the kit. In someembodiments, the container is a vial or an ampoule. In some embodiments,the non-allergenic antigen and/or immunosuppressant are contained withina solution separate from the container, such that the non-allergenicantigen and/or immunosuppressant may be added to the container at asubsequent time. In some embodiments, the non-allergenic antigen and/orimmunosuppressant are in lyophilized form each in a separate containeror in the same container, such that they may be reconstituted at asubsequent time. In some embodiments, the kit further comprisesinstructions for reconstitution, mixing, administration, etc. In someembodiments, the instructions include a description of the methodsdescribed herein. Instructions can be in any suitable form, e.g., as aprinted insert or a label. In some embodiments, the kit furthercomprises one or more syringes.

EXAMPLES Example 1 Evaluating Tolerogenic Immune Responses withSynthetic Nanocarriers Comprising Immunosuppressant In Vivo (Prophetic)

Method for Synthetic Nanocarrier Containing Rapamycin

A primary water-in-oil emulsion is prepared first. W1/O1 is prepared bycombining 0.13 M hydrochloric acid solution (0.2 mL), solution 2 (0.75mL), solution 3 (0.25 mL), and solution 4 (0.2 mL) in a small pressuretube and sonicating at 50% amplitude for 40 seconds using a BransonDigital Sonifier 250. A secondary emulsion (W1/O1/W2) is then preparedby combining solution 5 (3.0 mL) with the primary W1/O1 emulsion,vortexing for 10 s, and sonicating at 30% amplitude for 60 seconds usingthe Branson Digital Sonifier 250.

The W1/O1/W2 emulsion is added to a beaker containing 70 mM pH 8phosphate buffer solution (30 mL) and stirred at room temperature for 2hours to allow the methylene chloride to evaporate and for the syntheticnanocarriers to form. A portion of the synthetic nanocarriers are washedby transferring the synthetic nanocarrier suspension to a centrifugetube and centrifuging at 21,000×g and 4° C. for one hour, removing thesupernatant, and re-suspending the pellet in phosphate buffered saline.The washing procedure is repeated, and the pellet is re-suspended inphosphate buffered saline for a final synthetic nanocarrier dispersionof about 10 mg/mL. The amount of rapamycin in the synthetic nanocarrieris determined by HPLC analysis.

The total dry-synthetic nanocarrier mass per mL of suspension isdetermined by a gravimetric method.

Method for Measuring Rapamycin Load

Approximately 3 mg of synthetic nanocarriers are collected andcentrifuged to separate supernatant from synthetic nanocarrier pellet.Acetonitrile is added to the pellet, and the sample is sonicated andcentrifuged to remove any insoluble material. The supernatant and pelletare injected on RP-HPLC and absorbance is read at 278 nm. The μg foundin the pellet are used to calculate % entrapped (load), μg insupernatant and pellet are used to calculate total μg recovered.

Measurement of IgG

The level of IgG antibodies are measured. Blocker Casein in PBS (ThermoFisher, Catalog #37528) is used as diluent. 0.05% Tween-20 in PBS isused as wash buffer, prepared by adding 10 ml of Tween-20 ((Sigma,Catalog #P9416-100 mL) to 2 liters of a 10×PBS stock (PBS: OmniPur®10×PBS Liquid Concentrate, 4 L, EMD Chemicals, Catalog #6505) and 18Liters of deionized water.

Keyhole Limpet Hemocyanin (KLH) at a stock concentration of 5 mg/ml isused as a coating material. A 1:1000 dilution to 5 μg/ml is used as aworking concentration. Each well of the assay plates is coated with 100μl diluted OVA per well, plates are sealed with sealing film (VWRcatalog #60941-120), and incubated overnight at 4° C. Costar 901796-well Flat bottom plates are used as assay plates (Costar 9017).

Low-binding polypropylene 96-well plate or tubes are used as set-upplates, in which samples are prepared before being transferred to theassay plate. The setup plates did not contain any antigen and,therefore, serum antibodies did not bind to the plate during the setupof the samples. Setup plates are used for sample preparation to minimizebinding that might occur during preparation or pipetting of samples ifan antigen-coated plate is used to prepare the samples. Before preparingsamples in the setup plate, wells are covered with diluent to block anynon-specific binding and the plate is sealed and incubated at 4° C.overnight.

Assay plates are washed three times with wash buffer, and wash buffer iscompletely aspirated out of the wells after the last wash. Afterwashing, 300 μl diluent are added to each well of assay plate(s) toblock non-specific binding and plates are incubated at least 2 hours atroom temperature. Serum samples are prepared in the setup plate atappropriate starting dilutions. Starting dilutions are sometimes alsoprepared in 1.5 ml tubes using diluent and then transferred to theset-up plate. Appropriate starting dilutions are determined based onprevious data, where available. Where no previous data is available, thelowest starting dilution is 1:40. Once diluted, 200 μl of the startingdilution of the serum sample is transferred from the tube to theappropriate well of the setup plate.

Once all samples were prepared in the setup plate, the plate is sealedand stored at 4° C. until blocking of the assay plates is complete.Assay plates are washed three times with wash buffer, and wash buffer iscompletely aspirated after the last wash. After washing, 100 μL ofdiluent is added to wells in of the assay plates. A pipet is used totransfer samples from the setup plate to the assay plate. Samples aremixed prior to transfer by pipetting 150 μl of diluted serum up and down3 times. After mixing, 150 μl of each sample is transferred from thesetup plate and added to the respective assay plate.

Once the starting dilutions of each sample are transferred from thesetup plate to the assay plate, serial dilutions are pipetted on theassay plate as follows: 50 μl of each serum sample is removed using apipet and mixed with the 100 μl of diluent previously added. This stepis repeated down the entire plate. After pipetting the dilution of thefinal row, 50 μl of fluid is removed from the wells in the final row anddiscarded, resulting in a final volume of 100 μl in every well of theassay plate. Once sample dilutions are prepared in the assay plates, theplates are incubated at room temperature for at least 2 hours.

After the incubation, plates are washed three times with wash buffer.Detection antibody (Goat anti-mouse anti-IgG, HRP conjugated) is diluted1:1500 (0.33 μg/mL) in diluent and 100 μl of the diluted antibody isadded to each well. Plates are incubated for 1 hour at room temperatureand then washed three times with wash buffer, with each washing stepincluding a soak time of at least 30 seconds.

After washing, detection substrate is added to the wells. Equal parts ofsubstrate A and substrate B (BD Biosciences TMB Substrate Reagent Set,catalog #555214) are combined immediately before addition to the assayplates, and 100 μl of the mixed substrate solution are added to eachwell and incubated for 10 minutes in the dark. The reaction is stoppedby adding 50 μl of stop solution (2N H2SO4) to each well after the 10minute period. The optical density (OD) of the wells is assessedimmediately after adding the stop solution on a plate reader at 450 nmwith subtraction at 570 nm. Data analysis is performed using MolecularDevice's software SoftMax Pro v5.4. A four-parameter logistic curve-fitgraph is prepared with the dilution on the x-axis (log scale) and the ODvalue on the y-axis (linear scale), and the half maximum value (EC50)for each sample is determined. The plate template at the top of thelayout is adjusted to reflect the dilution of each sample (1 percolumn).

Example 2 Polymeric Nanocarrier Containing Polymer-Rapamycin Conjugate(Prophetic)

Preparation of PLGA-rapamycin Conjugate:

PLGA polymer with acid end group (7525 DLG1A, acid number 0.46 mmol/g,Lakeshore Biomaterials; 5 g, 2.3 mmol, 1.0 eq) is dissolved in 30 mL ofdichloromethane (DCM). N,N-Dicyclohexylcarbodimide (1.2 eq, 2.8 mmol,0.57 g) is added followed by rapamycin (1.0 eq, 2.3 mmol, 2.1 g) and4-dimethylaminopyridine (DMAP) (2.0 eq, 4.6 mmol, 0.56 g). The mixtureis stirred at rt for 2 days. The mixture is then filtered to removeinsoluble dicyclohexylurea. The filtrate is concentrated to ca. 10 mL involume and added to 100 mL of isopropyl alcohol (IPA) to precipitate outthe PLGA-rapamycin conjugate. The IPA layer is removed and the polymeris then washed with 50 mL of IPA and 50 mL of methyl t-butyl ether(MTBE). The polymer is then dried under vacuum at 35 C for 2 days togive PLGA-rapamycin as a white solid (ca. 6.5 g).

Nanocarrier containing PLGA-rapamycin is prepared according to theprocedure described in Example 1 as follows:

Solutions for nanocarrier formation are prepared as follows:

Solution 1: PLGA-rapamycin @100 mg/mL in methylene chloride. Thesolution is prepared by dissolving PLGA-rapamycin in pure methylenechloride. Solution 2: PLA-PEG @100 mg/mL in methylene chloride. Thesolution is prepared by dissolving PLA-PEG in pure methylene chloride.Solution 3: Polyvinyl alcohol @50 mg/mL in 100 mM pH 8 phosphate buffer.

A primary water-in-oil emulsion is prepared first. W1/O1 is prepared bycombining solution 1 (0.75 mL), and solution 2 (0.25 mL) in a smallpressure tube and sonicating at 50% amplitude for 40 seconds using aBranson Digital Sonifier 250. A secondary emulsion (W 1/O1/W2) is thenprepared by combining solution 3 (3.0 mL) with the primary W1/O1emulsion, vortexing for 10 s, and sonicating at 30% amplitude for 60seconds using the Branson Digital Sonifier 250. The W1/O1/W2 emulsion isadded to a beaker containing 70 mM pH 8 phosphate buffer solution (30mL) and stirred at room temperature for 2 hours to allow the methylenechloride to evaporate and for the nanocarriers to form. A portion of thenanocarriers is washed by transferring the nanocarrier suspension to acentrifuge tube and centrifuging at 75,600×g and 4° C. for 35 min,removing the supernatant, and re-suspending the pellet in phosphatebuffered saline. The washing procedure is repeated, and the pellet isre-suspended in phosphate buffered saline for a final nanocarrierdispersion of about 10 mg/mL.

Example 3 Preparation of Gold Nanocarriers (AuNCs) Containing Rapamycin(Prophetic)

Preparation of HS-PEG-rapamycin:

A solution of PEG acid disulfide (1.0 eq), rapamycin (2.0-2.5 eq), DCC(2.5 eq) and DMAP (3.0 eq) in dry DMF is stirred at rt overnight. Theinsoluble dicyclohexylurea is removed by filtration and the filtrate isadded to isopropyl alcohol (IPA) to precipitate out thePEG-disulfide-di-rapamycin ester and washed with IPA and dried. Thepolymer is then treated with tris(2-carboxyethyl)phosphine hydrochloridein DMF to reduce the PEG disulfide to thiol PEG rapamycin ester(HS-PEG-rapamycin). The resulting polymer is recovered by precipitationfrom IPA and dried as previously described and analyzed by H NMR andGPC.

Formation of Gold NCs (AuNCs):

An aq. solution of 500 mL of 1 mM HAuC14 is heated to reflux for 10 minwith vigorous stirring in a 1 L round-bottom flask equipped with acondenser. A solution of 50 mL of 40 mM of trisodium citrate is thenrapidly added to the stirring solution. The resulting deep wine redsolution is kept at reflux for 25-30 min and the heat is withdrawn andthe solution is cooled to room temperature. The solution is thenfiltered through a 0.8 μm membrane filter to give the AuNCs solution.The AuNCs are characterized using visible spectroscopy and transmissionelectron microscopy. The AuNCs are ca. 20 nm diameter capped by citratewith peak absorption at 520 nm.

AuNCs conjugate with HS-PEG-rapamycin:

A solution of 150 μl of HS-PEG-rapamycin (10 μM in 10 mM pH 9.0carbonate buffer) is added to 1 mL of 20 nm diameter citrate-capped goldnanocarriers (1.16 nM) to produce a molar ratio of thiol to gold of2500:1. The mixture is stirred at room temperature under argon for 1hour to allow complete exchange of thiol with citrate on the goldnanocarriers. The AuNCs with PEG-rapamycin on the surface is thenpurified by centrifuge at 12,000 g for 30 minutes. The supernatant isdecanted and the pellet containing AuNC—S-PEG-rapamycin is then pelletwashed with 1×PBS buffer. The purified Gold-PEG-rapamycin nanocarriersare then resuspend in suitable buffer for further analysis andbioassays.

Example 4 Synthetic Nanocarriers for use in the Inventive Methods andRelated Compositions

Materials

Rapamycin was purchased from TSZ CHEM (185 Wilson Street, Framingham,Mass. 01702; Product Catalogue # R1017). PLGA with 76% lactide and 24%glycolide content and an inherent viscosity of 0.69 dL/g was purchasedfrom SurModics Pharmaceuticals (756 Tom Martin Drive, Birmingham, Ala.35211. Product Code 7525 DLG 7A.) PLA-PEG block co-polymer with a PEGblock of approximately 5,000 Da and PLA block of approximately 40,000 Dawas purchased from SurModics Pharmaceuticals (756 Tom Martin Drive,Birmingham, Ala. 35211; Product Code 100 DL mPEG 5000 5CE). Polyvinylalcohol (85-89% hydrolyzed) was purchased from EMD Chemicals (ProductNumber 1.41350.1001).

Method

Solutions were prepared as follows:

Solution 1: PLGA at 75 mg/mL and PLA-PEG at 25 mg/mL in methylenechloride. The solution was prepared by dissolving PLGA and PLA-PEG inpure methylene chloride.

Solution 2: Rapamycin at 100 mg/mL in methylene chloride. The solutionwas prepared by dissolving rapamycin in pure methylene chloride.

Solution 3: Polyvinyl alcohol at 50 mg/mL in 100 mM pH 8 phosphatebuffer.

An oil-in-water emulsion was used to prepare the nanocarriers. The O/Wemulsion was prepared by combining solution 1 (1 mL), solution 2 (0.1mL), and solution 3 (3 mL) in a small pressure tube and sonicating at30% amplitude for 60 seconds using a Branson Digital Sonifier 250. TheO/W emulsion was added to a beaker containing 70 mM pH 8 phosphatebuffer solution (30 mL) and stirred at room temperature for 2 hours toallow the methylene chloride to evaporate and for the nanocarriers toform. A portion of the nanocarriers was washed by transferring thenanocarrier suspension to a centrifuge tube and centrifuging at 75,000×gand 4° C. for 35 min, removing the supernatant, and re-suspending thepellet in phosphate buffered saline. The washing procedure was repeated,and the pellet was re-suspended in phosphate buffered saline for a finalnanocarrier dispersion of about 10 mg/mL.

Nanocarrier size was determined by dynamic light scattering. The amountrapamycin in the nanocarrier was determined by HPLC analysis. The totaldry-nanocarrier mass per mL of suspension was determined by agravimetric method.

Effective Diameter Rapamycin Content (nm) (% w/w) 227 6.4

Example 5 Evaluating Tolerogenic Immune Responses Following ConcomitantAdministration of Synthetic Nanocarriers Comprising Immunosuppressantand Therapeutic Proteins

Tolerogenic Responses to Keyhole Limpet Hemocyanin

C57BL/6 age-matched (5-6 weeks) female were injected with 200 μg KeyholeLimpet Hemocyanin (KLH) in 200 μl PBS i.v. and administered according tothe schedule below. Injections for select groups were mixed with thesynthetic nanocarriers just prior to injection. Anti-KLH IgG antibodytiter was determined. The anaphylactic score induced by repetitive i.v.injections was also determined.

Immuni- zation Treatments KLH i.v. tSIP Rapa # Group 200 ug i.v.Description mice 1 d 0, 7, Control immunization 5 14, 21 2 d 7, 14,Control immunization 5 21 3 d 0, 7, 100 ug  Test whether highest dose to5 14, 21 d 0-21 inhibits the response 4 same 50 ug Test high dose toinhibits 5 d 0-21 the response 5 same 30 ug Test lowest dose to inhibits5 d 0-21 the response 6 same 10 ug Test ineffective dose to 5 d 0-21inhibits the response 7 same 100 ug Test whether highest dose 5 d 0tolerized towards an antigen 8 same 50 ug Test high dose to inhibits 5 d0 the response 9 same 30 ug Test lowest dose to inhibits 5 d 0 theresponse 10 same 10 ug Test ineffective dose to 5 d 0 inhibits theresponse 50

The results in FIG. 1 show that multiple doses of synthetic nanocarriersadministered concomitantly with KLH were effective in reducing theantibody response as observed at day 26. The animals presenting highantibody responses were eliminated from subsequent boosts. Only animalswith low or undetectable titers were kept as well as the control. Theseconsisted mainly of the animals having received multiple doses ofsynthetic nanocarriers at 100 μg, 50 μg and 30 μg. After day 21, allmice received 5 further injections of just KLH i.v. As seen in FIG. 2,untreated mice experienced a significant boost in their antibody titerswhile synthetic nanocarrier-treated mice had little to no antibodyincrease between days 21 to 54 (black symbols). Injection of KLH i.v.induces an anaphylaxic shock that can be evaluated by observing thefollowing symptons: 0 score represented normal behavior, 1 representeddecreased spontaneous activity, 2 represented decreased activity withfalling over and a loss of the self-righting reflex, and 3 was assignedto mice that became moribund with cool, cyanotic extremities (Liu, E.,et al. (2002). “Anti-peptide autoantibodies and fatal anaphylaxis in NODmice in response to insulin self-peptides B:9-23 and B:13-23.” Journalof Clinical Investigation 110(7): 1021-1027.). Similar to the titers,anaphylaxis was observed only in control animals, while little to noanaphylaxis was observed in synthetic nanocarrier-treated animals. Thus,it is shown that compositions provided herein when administered over aperiod of time concomitantly with a protein can reduce or preventantibody responses and the resulting anaphylaxis as a result ofadministration of the protein in a subject.

Example 6 Inhibition of Anaphylaxis in an OVA-Alum Model

Materials

Rapamycin was purchased from TSZ CHEM (185 Wilson Street, Framingham,Mass. 01702; Product Code R1017). PLGA with a lactide:glycolide ratio of3:1 and an inherent viscosity of 0.75 dL/g was purchased from SurModicsPharmaceuticals (756 Tom Martin Drive, Birmingham, Ala. 35211; ProductCode 7525 DLG 7A). PLA-PEG-OMe block co-polymer with a methyl etherterminated PEG block of approximately 5,000 Da and an overall inherentviscosity of 0.5 DL/g was purchased from Lakeshore Biochemicals (756 TomMartin Drive, Birmingham, Ala. 35211; Product Code 100 DL mPEG 50005CE). EMPROVE® Polyvinyl Alcohol 4-88, USP (85-89% hydrolyzed, viscosityof 3.4-4.6 mPa·s) was purchased from EMD Chemicals Inc. (480 SouthDemocrat Road Gibbstown, N.J. 08027. Product Code 1.41350).

Method

Solutions were prepared as follows:

Solution 1: PLGA at 75 mg/mL, PLA-PEG-OMe at 25 mg/mL, and rapamycin at12.5 mg/mL in methylene chloride. The solution was prepared bydissolving PLGA, PLA-PEG-OMe, and rapamycin in pure methylene chloride.Solution 2: Polyvinyl alcohol @50 mg/mL in 100 mM pH 8 phosphate buffer.

An oil-in-water emulsion was used to prepare the nanocarriers. The O/Wemulsion was prepared by combining Solution 1 (1.0 mL) and Solution 2(3.0 mL) in a small pressure tube and sonicating at 30% amplitude for 60seconds using a Branson Digital Sonifier 250. The O/W emulsion was addedto a beaker containing 70 mM pH 8 phosphate buffer solution and stirredat room temperature for 2 hours to allow the methylene chloride toevaporate and for the nanocarriers to form. A portion of thenanocarriers was washed by transferring the nanocarrier suspension to acentrifuge tube and centrifuging at 75,600×g and 4° C. for 50 min,removing the supernatant, and re-suspending the pellet in phosphatebuffered saline. The washing procedure was repeated, and the pellet wasre-suspended in phosphate buffered saline for a final nanocarrierdispersion of about 10 mg/mL.

Nanocarrier size was determined by dynamic light scattering. The amountof rapamycin in the nanocarrier was determined by HPLC analysis. Thetotal dry-nanocarrier mass per mL of suspension was determined by agravimetric method.

Effective Diameter Rapamycin Content (nm) (% w/w) 241 11.5Suppression of Intravenously-Induced Anaphylactic Reactions usingTolerogenic Nanocarriers

Control Balb/c age-matched (5-6 weeks) female mice (d0) were left naïveor injected twice intraperitoneously (i.p., d0 an d5) with 5 μg of wholeOvalbumin protein with 4 μg of Alum (OVA+Alum). Other groups received asimilar injection but 100 μg of Rapamycin were injected free in solutioni.v. or contained in 0.9 mg of synthetic nanocarriers i.p. (admixed tothe OVA+Alum), intragastrically (i.g.) intravenously (i.v.) (tail vein)or subcutaneously (hind limb). Fifteen days later all animals werechallenged with a bolus of OVA i.v. (25 pg). As expected, animals thatwere not immunized did not react to the OVA infusion whereas a stronganaphylaxis reaction was recorded in untreated immunized animals asshown in FIG. 3. Treatment of the animals with free rapamycin orsynthetic nanocarriers i.g. did not reduce the anaphylactic reactionwhereas providing the synthetic nanocarriers i.v., i.p. or s.c.abolished it.

These results show that compositions provided herein when administeredconcomitantly with a protein can reduce or prevent anaphylaxis inducedby an infusion of the protein. Anaphylaxis scores were determined bythree independent observers as follows: 0=no symptom, 1=lethargy,2=lethargy and inability to right, 3=moribund. The bars represent themean+/−standard error.

Example 7 Antigen-Specific Tolerogenic Responses to Chicken Ovalbuminwith Encapsulated Rapamycin

NP[Rapa] Materials and Methods

Materials

Rapamycin was purchased from TSZ CHEM (185 Wilson Street, Framingham,Mass. 01702), product code R1017. PLGA with a lactide:glycolide ratio of1:1 and an inherent viscosity of 0.24 dL/g was purchased from LakeshoreBiomaterials (756 Tom Martin Drive, Birmingham, Ala. 35211), productcode 5050 DLG 2.5A. PLA-PEG-OMe block co-polymer with a methyl etherterminated PEG block of approximately 5,000 Da and an overall inherentviscosity of 0.50 DL/g was purchased from Lakeshore Biomaterials (756Tom Martin Drive, Birmingham, Ala. 35211), product code 100 DL mPEG 50005CE. EMPROVE® Polyvinyl Alcohol 4-88, USP (85-89% hydrolyzed, viscosityof 3.4-4.6 mPa·s) was purchased from EMD Chemicals Inc. (480 SouthDemocrat Road Gibbstown, N.J. 08027), product code 1.41350. Cellgrophosphate buffered saline 1× (PBS 1×) was purchased from Corning (9345Discovery Blvd. Manassas, Va. 20109), product code 21-040-CV.

Method

Solutions were prepared as follows:

Solution 1: A polymer and rapamycin mixture was prepared by dissolvingPLGA at 75 mg per 1 mL, PLA-PEG-Ome at 25 mg per 1 mL, and rapamycin as12.5 mg per 1 mL in dichloromethane. Solution 2: Polyvinyl alcohol wasprepared at 50 mg/mL in 100 mM pH 8 phosphate buffer.

An O/W emulsions was prepared by combining Solution 1 (1.0 mL) andSolution 2 (3.0 mL) in a small glass pressure tube and sonicating at 30%amplitude for 60 seconds using a Branson Digital Sonifier 250. The O/Wemulsion was added to an open beaker containing 70 mM pH 8 phosphatebuffer solution (60 mL). Three additional, identical O/W emulsions wereprepared and added to the same beaker as the first. These were thenstirred at room temperature for 2 hours to allow the dichloromethane toevaporate and for the nanocarriers to form. A portion of thenanocarriers was washed by transferring the nanocarrier suspension tocentrifuge tubes and centrifuging at 75,600×g and 4° C. for 35 minutes,removing the supernatant, and re-suspending the pellet in PBS 1×. Thewash procedure was repeated and then the pellet was re-suspended in PBS1× to achieve a nanocarrier suspension having a nominal concentration of10 mg/mL on a polymer basis. An identical formulation was prepared asabove in a separate beaker, and combined with the first after the washstep. The mixed nanocarrier solution was then filtered using 1.2 μm PESmembrane syringe filters from Pall part number 4656, and stored at −20°C.

Nanocarrier size was determined by dynamic light scattering. The amountof rapamycin in the nanocarrier was determined by HPLC analysis. Thetotal dry-nanocarrier mass per mL of suspension was determined by agravimetric method.

Effective Diameter Rapamycin Content (nm) (% w/w) 220 11.85NP[OVA] Materials and MethodsMaterials

Ovalbumin protein, was purchased from Worthington BiochemicalCorporation (730 Vassar Avenue, Lakewood, N.J. 08701), product codeLS003054). PLGA with 54% lactide and 46% glycolide content and aninherent viscosity of 0.24 dL/g was purchased from LakeshoreBiomaterials (756 Tom Martin Drive, Birmingham, Ala. 35211), productcode 5050 DLG 2.5A). PLA-PEG block co-polymer with a methyl etherterminated PEG block of approximately 5,000 Da and Mw of 28,000 Da,inherent viscosity of 0.38 dL/g was purchased from LakeshoreBiomaterials (756 Tom Martin Drive, Birmingham, Ala. 35211), productcode 100 DL mPEG 5000 4CE. EMPROVE® Polyvinyl Alcohol 4-88, USP, 85-89%hydrolyzed, viscosity of 3.4-4.6 mPa·s, was purchased from EMD ChemicalsInc. (480 South Democrat Road Gibbstown, N.J. 08027), product code1.41350.1001. Cellgro Phosphate-buffered saline 1× (PBS 1×) waspurchased from Corning (9345 Discovery Blvd. Manassas, Va. 20109),product code 21-040-CV.

Method

Solutions were prepared as follows:

Solution 1: Ovalbumin protein @50 mg/mL was prepared in 10 mM phosphatebuffer pH 8 with 10% by weight sucrose. Solution 2: PLGA was prepared bydissolving PLGA at 100 mg per 1 mL of dichloromethane in the chemicalfume hood. Solution 3: PLA-PEG-OMe was prepared by dissolvingPLA-PEG-OMe at 100 mg per 1 mL of dichloromethane in the chemical fumehood. Solution 4: Polyvinyl alcohol @65 mg/mL in 100 mM phosphatebuffer, pH 8.

A primary (W1/O) emulsion was first created by mixing Solutions 1through 3. Solution 1 (0.2 mL), Solution 2 (0.75 mL), and Solution 3(0.25 mL) were combined in a small glass pressure tube which waspre-chilled >4 minutes in an ice water bath, and sonicated at 50%amplitude for 40 seconds over an ice bath using a Branson DigitalSonifier 250. A secondary (W1/O/W2) emulsion was then formed by addingSolution 4 (3 mL) to the primary emulsion, vortex mixing to create amilky dispersion, and then sonicating at 30% amplitude for 60 secondsover an ice bath using the Branson Digital Sonifier 250. The secondaryemulsion was added to an open 50 mL beaker containing PBS 1× (30 mL). Asecond identical double emulsion formulation was prepared as describedabove, and added to the same 50 mL beaker as the first. The twopreparations were stirred at room temperature for 2 hours to allow thedichloromethane to evaporate and the nanocarriers to form in suspension.A portion of the suspended nanocarriers was washed by transferring thenanocarrier suspension to a centrifuge tube, spinning at 75,600 rcf for50 minutes, removing the supernatant, and re-suspending the pellet inPBS 1×. This washing procedure was repeated and then the pellet wasre-suspended in PBS 1× to achieve a nanocarrier suspension having anominal concentration of 10 mg/mL on a polymer basis. The suspension wasstored frozen at −20° C. until use.

Effective Diameter Ovalbumin Content (nm) (% w/w) 164 5.81NP[GSK1059615] Materials and MethodsMaterials

GSK1059615 was purchased from MedChem Express (11 Deer Park Drive, Suite102D Monmouth Junction, N.J. 08852), product code HY-12036. PLGA with alactide:glycolide ratio of 1:1 and an inherent viscosity of 0.24 dL/gwas purchased from Lakeshore Biomaterials (756 Tom Martin Drive,Birmingham, Ala. 35211), product code 5050 DLG 2.5A. PLA-PEG-OMe blockco-polymer with a methyl ether terminated PEG block of approximately5,000 Da and an overall inherent viscosity of 0.26 DL/g was purchasedfrom Lakeshore Biomaterials (756 Tom Martin Drive, Birmingham, Ala.35211; Product Code 100 DL mPEG 5000 5K-E). Cellgro phosphate bufferedsaline 1×pH 7.4 (PBS 1×) was purchased from Corning (9345 DiscoveryBlvd. Manassas, Va. 20109), product code 21-040-CV.

Method

Solutions were prepared as follows:

Solution 1: PLGA (125 mg), and PLA-PEG-OMe (125 mg), were dissolved in10 mL of acetone. Solution 2: GSK1059615 was prepared at 10 mg in 1 mLof N-methyl-2-pyrrolidinone (NMP).

Nanocarriers were prepared by combining Solution 1 (4 mL) and Solution 2(0.25 mL) in a small glass pressure tube and adding the mixture dropwise to a 250 mL round bottom flask containing 20 mL of ultra-pure waterunder stirring. The flask was mounted onto a rotary evaporation device,and the acetone was removed under reduced pressure. A portion of thenanocarriers was washed by transferring the nanocarrier suspension tocentrifuge tubes and centrifuging at 75,600 rcf and 4° C. for 50minutes, removing the supernatant, and re-suspending the pellet in PBS1×. The washing procedure was repeated, and the pellet was re-suspendedin PBS 1× to achieve a nanocarrier suspension having a nominalconcentration of 10 mg/mL on a polymer basis. The washed nanocarriersolution was then filtered using 1.2 μm PES membrane syringe filtersfrom Pall, part number 4656. An identical nanocarrier solution wasprepared as above, and pooled with the first after the filtration step.The homogenous suspension was stored frozen at −20° C.

Nanocarrier size was determined by dynamic light scattering. The amountof GSK1059615 in the nanocarrier was determined by UV absorption at 351nm. The total dry-nanocarrier mass per mL of suspension was determinedby a gravimetric method.

Effective Diameter GSK1059615 Content (nm) (% w/w) 143 1.02

C57BL/6 age-matched (5-6 weeks) female mice were injected i.v. in thetail vein on days −21 and −14 with saline (No Treatment), 1.1 mg ofwhole Ovalbumin-loaded nanocarriers (NP[OVA]) combined to either 1.2 mgof rapamycin-containing nanocarriers (NP[Rapa]) or 8 mg ofGSK1059615-loaded nanocarriers (NP[GSK1059615]).

At day 0 all animals were injected s.c. in the hind limbs with 25 μg ofparticulate OVA (pOVA) admixed to 2 μg of CpG followed by injections ofjust 25 μg pOVA on days 7 and 14. Antibody titers were measured on day21. In absence of any treatment, the animals developed a robust immuneresponse against OVA that can be measured by the anti-OVA IgG antibodytiters. The antibody titers at day 21 shown in FIG. 4 demonstrate that 2doses of synthetic tolerogenic nanocarriers administered concomitantlywith encapsulated OVA in the same solution (NP[OVA]+NP[Rapa] orNP[GSK1059615]) were effective in reducing antibody formation to OVAeven after 1 injection of OVA+CpG and 2 injections of OVA alone. Theseresults show that encapsulated immunosuppressants (such as rapamycin andGSK1059615]) when concomitantly delivered with a protein can preventantibody formation to that protein for multiple challenges and periodsof time, such an effect is helpful in reducing or preventing theoccurrence of anaphylaxis.

Example 8 Allergenic IgE-Mediated Anaphylaxis versus IgG-MediatedAnaphylaxis (Prophetic)

Subjects that have allergies to latex and subjects that have presentedwith anaphylaxis following infusion of von Willebrand's factor (“vWF”)are recruited for a set of pharmacodynamic studies. Anaphylaxis isinduced in the two sets of subjects, and blood samples are taken before,during, and following anaphylactic episodes.

The blood samples are assayed for increased T cell IL4R-α expression,and decreased blood neutrophil FcγRIII expression. In latex allergenicsubjects, increased T cell IL4R-α expression, without decreased bloodneutrophil FcγRIII expression is characterized as being indicative ofallergenic IgE-mediated anaphylaxis. In vWF sensitized subjects,decreased blood neutrophil FcγRIII expression, without T cell IL4R-αexpression is characterized as being indicative of IgG-mediatedanaphylaxis.

Example 9 Monoclonal Antibody-Induced Anaphylaxis (Prophetic)

Subjects are repeatedly exposed to infliximab (REMICADE), and anypresentation of anaphylaxis in the subjects is noted. Blood samples aretaken from the subjects before, during, and following anaphylacticepisodes.

The blood samples are assayed for increased T cell IL4R-α expression,and decreased blood neutrophil FcγRIII expression. Decreased bloodneutrophil FcγRIII expression, without T cell IL4R-α expression ischaracterized as being indicative of IgG-mediated anaphylaxis.

Example 10 Messenger RNA-Induced Anaphylaxis (Prophetic)

Modified mRNA encoding erythropoietin is prepared according to US Patentapplication 2013/0115272 to de Fougerolles et al. (“mmRNA”). Subjectsare repeatedly exposed to mmRNA, and any presentation of anaphylaxis inthe subjects is noted. Blood samples are taken from the subjects before,during, and following anaphylactic episodes.

The blood samples are assayed for increased T cell IL4R-α expression,and decreased blood neutrophil FcγRIII expression. Decreased bloodneutrophil FcγRIII expression, without T cell IL4R-α expression ischaracterized as being indicative of IgG-mediated anaphylaxis.

Example 11 Antigen-Specific Tolerogenic Responses to Chicken Ovalbuminwith Nanocrytalline Rapamycin (Prophetic)

C57BL/6 age-matched (5-6 weeks) female mice are injected i.v. in thetail vein on days −21 and −14 with saline (No Treatment) or 1.1 mg ofwhole Ovalbumin and 1.2 mg of nanocrystalline rapamycin. At day 0 allanimals are injected s.c. in the hind limbs with 25 μg of particulateOVA (pOVA) admixed to 2 μg of CpG followed by injections of just 25 μgpOVA on days 7 and 14. Antibody titers are measured on day 21. In theabsence of any treatment, the animals develop a robust immune responseagainst OVA that can be measured by the anti-OVA IgG antibody titers.

A reduction in OVA-specific IgG antibodies in the animals that receivedOVA in combination with nanocrystalline rapamycin indicates that thenanocrystal-form of the immunosuppressant when concomitantly deliveredwith antigen can prevent antibody formation to the antigen for multiplechallenges and periods of time and can be useful in reducing orpreventing anaphylaxis.

Example 12 Reduction of Monoclonal Antibody-Induced Anaphylaxis withNanocarriers (Prophetic)

Subjects are repeatedly exposed to infliximab (REMICADE). Control groupsare left untreated (No Treatment) whereas three other groups are treatedwith synthetic nanocarriers attached to GSK1059615 (NP[GSK]). Bloodsamples are taken from the subjects before, during, and followinganaphylactic episodes. The extent of anaphylaxis in response to REMICADEis assessed and the titer of REMICADE-specific IgG antibody titers inthe blood of the animals is quantified. The blood samples are alsoassayed for increased T cell IL4R-α expression, and decreased bloodneutrophil FcγRIII expression.

A reduction in the symptoms of anaphylaxis and/or the titer ofanti-REMICADE IgG antibodies in the animals that were exposed toREMICADE concomitantly with nanocarriers attached to GSK1059615 ascompared to animals that did not received the nanocarrier compositionsindicates that the nanocarriers attached to GSK1059615 whenconcomitantly delivered with an antigen, such as REMICADE, is able toreduce or prevent anaphylaxis.

Example 13 Allergenic IgE-Mediated Anaphylaxis versus IgG-MediatedAnaphylaxis (Prophetic)

Subjects that have allergies to latex and subjects that have presentedwith anaphylaxis following infusion of von Willebrand's factor (“vWF”)are recruited for a set of pharmacodynamic studies. Anaphylaxis isinduced in the two sets of subjects in the presence or absence ofnanocrystalline rapamycin, and blood samples are taken before, during,and following anaphylactic episodes.

The blood samples are assayed for increased T cell IL4R-α expression,and decreased blood neutrophil FcγRIII expression. In latex allergenicsubjects, increased T cell IL4R-α expression, without decreased bloodneutrophil FcγRIII expression is characterized as being indicative ofallergenic IgE-mediated anaphylaxis. In vWF sensitized subjects,decreased blood neutrophil FRIII expression, without T cell IL4Rexpression is characterized as being indicative of IgG-mediatedanaphylaxis. A reduction in vWF-specific responses in the subjects thatreceived nanocrystalline rapamycin as compared to the subjects that didnot, indicates that the nanocrystalline immunosuppressant is able toreduce or prevent anaphylaxis.

Example 14 Messenger RNA-Induced Anaphylaxis (Prophetic)

Modified mRNA encoding erythropoietin is prepared according to US Patentapplication 2013/0115272 to de Fougerolles et al. (“mmRNA”). Subjectsare repeatedly exposed to mmRNA in the presence or absence ofnanocrystalline rapamycin, and any presentation of anaphylaxis in thesubjects is noted. Blood samples are taken from the subjects before,during, and following anaphylactic episodes.

The blood samples are assayed for increased T cell IL4R-α expression,and decreased blood neutrophil FcγRIII expression. Decreased bloodneutrophil FcγRIII expression, without T cell IL4R-α expression ischaracterized as being indicative of IgG-mediated anaphylaxis. Areduction in mmRNA-specific responses in the subjects that receivednanocrystalline rapamycin as compared to the subjects that did not,indicates that the nanocrystalline immunosuppressant is able to reduceor prevent anaphylaxis.

What is claimed is:
 1. A method for reducing or preventing ananaphylactic reaction to a non-allergenic antigen, comprising: providingthe non-allergenic antigen, the non-allergenic antigen being unattachedto synthetic nanocarriers; providing a composition comprising syntheticnanocarriers attached to an mTOR inhibitor; and administering to asubject having or at risk of having an anaphylactic reaction to anon-allergenic antigen the composition concomitantly with thenon-allergenic antigen prior to subsequent administration of thenon-allergenic antigen without administration of the composition.
 2. Themethod of claim 1, wherein the concomitant administration to the subjectis according to a protocol that has been demonstrated to reduce orprevent an anaphylactic reaction.
 3. The method of claim 1, wherein themethod further comprises assessing the anaphylactic reaction in thesubject prior to and/or after the administration.
 4. The method of claim1, wherein the administering is by intravenous, intraperitoneal orsubcutaneous administration.
 5. The method of claim 1, wherein themethod further comprises recording a reduction or prevention of ananaphylactic reaction to the non-allergenic antigen.
 6. The method ofclaim 1, wherein the non-allergenic antigen comprises a therapeuticmacromolecule.
 7. The method of claim 6, wherein the therapeuticmacromolecule is a therapeutic protein or a therapeutic polynucleotide.8. The method of claim 7, wherein the therapeutic protein comprises a/aninfusible or injectable therapeutic protein, a protein for proteinreplacement or protein supplementation therapy, enzyme, enzyme cofactor,hormone, blood or blood coagulation factor, cytokine, interferon, growthfactor, monoclonal antibody, polyclonal antibody, or protein associatedwith Pompe's disease.
 9. The method of claim 8, wherein the infusible orinjectable therapeutic protein comprises Tocilizumab, alpha-1antitrypsin, Hematide, albinterferon alfa-2b, Thucin, tesamorelin,ocrelizumab, belimumab, pegloticase, taliglucerase alfa, agalsidasealfa, velaglucerase alfa, imiglucerase, a-galactosidase A (a-gal A),agalsidase beta, acid α-glucosidase (GAA), alglucosidase alfa,arylsulfatase B, laronidase, idursulfase, arylsulfatase B, pegsiticaseor galsulfase.
 10. The method of claim 8, wherein the enzyme comprisesan oxidoreductase, transferase, hydrolase, lysase, isomerase, ligase oran enzyme for enzyme replacement therapy for a lysosomal storagedisorder.
 11. The method of claim 8, wherein the cytokine comprises alymphokine, interleukin, chemokine, type 1 cytokine or a type 2cytokine.
 12. The method of claim 8, wherein the blood or bloodcoagulation factor comprises Factor I, Factor II, tissue factor, FactorV, Factor VII, Factor VIII, Factor IX, Factor X, Factor Xa, Factor XII,Factor XIII, von Willebrand factor, prekallikrein, high-molecular weightkininogen, fibronectin, antithrombin III, heparin cofactor II, proteinC, protein S, protein Z, protein Z-related protease inhibitor (ZPI),plasminogen, alpha 2-antiplasmin, tissue plasminogen activator (tPA),urokinase, plasminogen activator inhibitor-1 (PAI1), plasminogenactivator inhibitor-2 (PAI2), cancer procoagulant or epoetin alfa. 13.The method claim 1, wherein a load of mTOR inhibitor attached to thesynthetic nanocarriers, on average across the synthetic nanocarriers, isbetween 0.1% and 50%.
 14. The method of claim 1, wherein the syntheticnanocarriers comprise lipid nanoparticles, polymeric nanoparticles,metallic nanoparticles, surfactant-based emulsions, dendrimers,buckyballs, nanowires, virus-like particles or peptide or proteinparticles.
 15. The method claim 1, wherein the mean of a particle sizedistribution obtained using dynamic light scattering of the syntheticnanocarriers is a diameter greater than 100 nm.
 16. The method of claim1, wherein an aspect ratio of the synthetic nanocarriers is greater than1:1, 1:1.2, 1:1.5, 1:2, 1:3, 1:5, 1:7 or 1:10.